Skip to main content
PMC home page
Annals of The Royal College of Surgeons of England logoLink to Annals of The Royal College of Surgeons of England
. 1990 Jan;72(1):53–59.

Large bowel cancer: the effect of perioperative blood transfusion on outcome.

S Cheslyn-Curtis 1, L P Fielding 1, R Hittinger 1, J S Fry 1, R K Phillips 1
PMCID: PMC2499079  PMID: 2405765

Abstract

Perioperative blood transfusion has been reported to adversely affect survival in cancer patients, but the evidence is inconclusive and may be an epiphenomenon. From the Large Bowel Cancer Project, 961 patients who underwent curative resection and left hospital alive have been reviewed to compare the effect of perioperative blood transfusion on outcome; 591 patients (61%) had been given a blood transfusion while 370 (39%) had not been transfused. Some clinical variables were equally distributed between the two groups; ie age, sex, obstruction, perforation, tumour differentiation. Three other variables known to influence patient prognosis were not equally distributed, ie tumour site, Dukes' stage and tumour mobility. Patients with tumours of the rectum and rectosigmoid, with Dukes' stage C lesions and with some degree of tumour fixation were more likely to have received blood transfusions. Using the logrank method of multivariate analysis to allow for differences in distribution of all those variables known to affect prognosis, there was no survival disadvantage for those patients who had received perioperative blood transfusion. Furthermore, there were no overall differences between the two groups of patients in their risk of developing local tumour recurrence or distant metastases. The distribution of metastases differed: in the 'transfused' group only 37% of distant metastases were found in the liver, while 71% were found in this site in the 'not transfused' group (chi 2 = 18.46, d.f. = 1, P less than 0.001). By contrast, there was a larger proportion of patients with lung metastases in the transfused group (27% vs 11%) (chi 2 = 5.59, d.f. = 1, P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Full text

PDF
53

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Aldridge M. C., Phillips R. K., Hittinger R., Fry J. S., Fielding L. P. Influence of tumour site on presentation, management and subsequent outcome in large bowel cancer. Br J Surg. 1986 Aug;73(8):663–670. doi: 10.1002/bjs.1800730829. [DOI] [PubMed] [Google Scholar]
  2. Blumberg N., Agarwal M. M., Chuang C. Relation between recurrence of cancer of the colon and blood transfusion. Br Med J (Clin Res Ed) 1985 Apr 6;290(6474):1037–1039. doi: 10.1136/bmj.290.6474.1037. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Blumberg N., Heal J. M., Murphy P., Agarwal M. M., Chuang C. Association between transfusion of whole blood and recurrence of cancer. Br Med J (Clin Res Ed) 1986 Aug 30;293(6546):530–533. doi: 10.1136/bmj.293.6546.530. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Burrows L., Tartter P. Effect of blood transfusions on colonic malignancy recurrent rate. Lancet. 1982 Sep 18;2(8299):662–662. doi: 10.1016/s0140-6736(82)92764-7. [DOI] [PubMed] [Google Scholar]
  5. CUTLER S. J., EDERER F. Maximum utilization of the life table method in analyzing survival. J Chronic Dis. 1958 Dec;8(6):699–712. doi: 10.1016/0021-9681(58)90126-7. [DOI] [PubMed] [Google Scholar]
  6. Creasy T. S., Veitch P. S., Bell P. R. A relationship between perioperative blood transfusion and recurrence of carcinoma of the sigmoid colon following potentially curative surgery. Ann R Coll Surg Engl. 1987 May;69(3):100–103. [PMC free article] [PubMed] [Google Scholar]
  7. Eilber F. R., Morton D. L. Impaired immunologic reactivity and recurrence following cancer surgery. Cancer. 1970 Feb;25(2):362–367. doi: 10.1002/1097-0142(197002)25:2<362::aid-cncr2820250213>3.0.co;2-v. [DOI] [PubMed] [Google Scholar]
  8. Fielding L. P., Phillips R. K., Fry J. S., Hittinger R. Prediction of outcome after curative resection for large bowel cancer. Lancet. 1986 Oct 18;2(8512):904–907. doi: 10.1016/s0140-6736(86)90422-8. [DOI] [PubMed] [Google Scholar]
  9. Foster R. S., Jr, Costanza M. C., Foster J. C., Wanner M. C., Foster C. B. Adverse relationship between blood transfusions and survival after colectomy for colon cancer. Cancer. 1985 Mar 15;55(6):1195–1201. doi: 10.1002/1097-0142(19850315)55:6<1195::aid-cncr2820550610>3.0.co;2-h. [DOI] [PubMed] [Google Scholar]
  10. Foster R. S., Jr, Foster J. C., Costanza M. C. Blood transfusions and survival after surgery for breast cancer. Arch Surg. 1984 Oct;119(10):1138–1140. doi: 10.1001/archsurg.1984.01390220024005. [DOI] [PubMed] [Google Scholar]
  11. Francis D. M., Judson R. T. Blood transfusion and recurrence of cancer of the colon and rectum. Br J Surg. 1987 Jan;74(1):26–30. doi: 10.1002/bjs.1800740110. [DOI] [PubMed] [Google Scholar]
  12. Frankish P. D., McNee R. K., Alley P. G., Woodfield D. G. Relation between cancer of the colon and blood transfusion. Br Med J (Clin Res Ed) 1985 Jun 15;290(6484):1827–1827. doi: 10.1136/bmj.290.6484.1827-b. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Hyman N. H., Foster R. S., Jr, DeMeules J. E., Costanza M. C. Blood transfusions and survival after lung cancer resection. Am J Surg. 1985 Apr;149(4):502–507. doi: 10.1016/s0002-9610(85)80047-7. [DOI] [PubMed] [Google Scholar]
  14. Matas A. J., Simmons R. L., Kjellstrand C. M., Buselmeier T. J., Najarian J. S. Increased incidence of malignancy during chronic renal failure. Lancet. 1975 Apr 19;1(7912):883–886. doi: 10.1016/s0140-6736(75)91684-0. [DOI] [PubMed] [Google Scholar]
  15. Nathanson S. D., Tilley B. C., Schultz L., Smith R. F. Perioperative allogeneic blood transfusions. Survival in patients with resected carcinomas of the colon and rectum. Arch Surg. 1985 Jun;120(6):734–738. doi: 10.1001/archsurg.1985.01390300076013. [DOI] [PubMed] [Google Scholar]
  16. Nowak M. M., Ponsky J. L. Blood transfusion and disease-free survival in carcinoma of the breast. J Surg Oncol. 1984 Oct;27(2):124–130. doi: 10.1002/jso.2930270214. [DOI] [PubMed] [Google Scholar]
  17. Ota D., Alvarez L., Lichtiger B., Giacco G., Guinee V. Perioperative blood transfusion in patients with colon carcinoma. Transfusion. 1985 Jul-Aug;25(4):392–394. doi: 10.1046/j.1537-2995.1985.25485273825.x. [DOI] [PubMed] [Google Scholar]
  18. Parrott N. R., Lennard T. W., Taylor R. M., Proud G., Shenton B. K., Johnston I. D. Effect of perioperative blood transfusion on recurrence of colorectal cancer. Br J Surg. 1986 Dec;73(12):970–973. doi: 10.1002/bjs.1800731208. [DOI] [PubMed] [Google Scholar]
  19. Peto R., Pike M. C. Conservatism of the approximation sigma (O-E)2-E in the logrank test for survival data or tumor incidence data. Biometrics. 1973 Sep;29(3):579–584. [PubMed] [Google Scholar]
  20. Phillips R. K., Hittinger R., Blesovsky L., Fry J. S., Fielding L. P. Large bowel cancer: surgical pathology and its relationship to survival. Br J Surg. 1984 Aug;71(8):604–610. doi: 10.1002/bjs.1800710813. [DOI] [PubMed] [Google Scholar]
  21. Rosenberg S. A., Seipp C. A., White D. E., Wesley R. Perioperative blood transfusions are associated with increased rates of recurrence and decreased survival in patients with high-grade soft-tissue sarcomas of the extremities. J Clin Oncol. 1985 May;3(5):698–709. doi: 10.1200/JCO.1985.3.5.698. [DOI] [PubMed] [Google Scholar]
  22. Saba T. M., Antikatzides T. G. Decreased resistance to intravenous tumour-cell challenge during reticuloendothelial depression following surgery. Br J Cancer. 1976 Oct;34(4):381–389. doi: 10.1038/bjc.1976.181. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Tartter P. I. Blood transfusion and infectious complications following colorectal cancer surgery. Br J Surg. 1988 Aug;75(8):789–792. doi: 10.1002/bjs.1800750822. [DOI] [PubMed] [Google Scholar]
  24. Tartter P. I., Burrows L., Kirschner P. Perioperative blood transfusion adversely affects prognosis after resection of Stage I (subset N0) non-oat cell lung cancer. J Thorac Cardiovasc Surg. 1984 Nov;88(5 Pt 1):659–662. [PubMed] [Google Scholar]
  25. Tartter P. I., Burrows L., Papatestas A. E., Lesnick G., Aufses A. H., Jr Perioperative blood transfusion has prognostic significance for breast cancer. Surgery. 1985 Feb;97(2):225–230. [PubMed] [Google Scholar]
  26. Terasaki P. I. The beneficial transfusion effect on kidney graft survival attributed to clonal deletion. Transplantation. 1984 Feb;37(2):119–125. doi: 10.1097/00007890-198402000-00001. [DOI] [PubMed] [Google Scholar]
  27. White H., Griffiths J. D. Circulating malignant cells and fibrinolysis during resection of colorectal cancer. Proc R Soc Med. 1976 Jul;69(7):467–469. [PMC free article] [PubMed] [Google Scholar]
  28. Woodruff M. F., van Rood J. J. Possible implications of the effect of blood transfusion on allograft survival. Lancet. 1983 May 28;1(8335):1201–1203. doi: 10.1016/s0140-6736(83)92476-5. [DOI] [PubMed] [Google Scholar]

Articles from Annals of The Royal College of Surgeons of England are provided here courtesy of The Royal College of Surgeons of England

RESOURCES