The influence of perioperative blood transfusion on survival after esophageal resection for XXXX .

@entity1 @entity5 @entity190 @entity189 @entity2802 @entity420
BACKGROUND: There is evidence that perioperative blood transfusion may lead to immunosuppression. Our aim was to determine whether blood transfusion influenced survival after esophagectomy for @entity189 . METHODS: The study group comprised 234 consecutive @entity1 (175 @entity1 and 59 @entity1 ) with a mean age of 66 years who underwent esophagectomy for @entity189 by one surgeon between 1988 and 1998. The impact of 41 variables on survival was determined by means of univariate and multivariate analysis. Follow-up was complete (mean follow-up, 19.2 months; standard deviation, 16 months; range, 0 to 129 months). RESULTS: The operative mortality rate was 5.6% (13 deaths). Median operative @entity190 was 700 mL (range, 150 to 7,000 mL). One hundred sixty-one @entity1 (68.8%) received a blood transfusion postoperatively (mean transfusion, 2.6 units; range, 0 to 12 units). Overall actuarial 1-year, 3-year, and 5-year survival rates inclusive of operative mortality were 58.1%, 28.5%, and 16.1%, respectively. On univariate analysis, positive lymph nodes, pathological @entity2802 stage, transfusion of more than 3 units of blood, incomplete resection, poor @entity5 cell differentiation, @entity5 , greater weight loss, male sex, and @entity420 were significant (p < 0.05) negative factors for survival. On Cox proportional hazards regression analysis, after excluding operative mortality, lymph node involvement (p = 0.001), incomplete resection (p = 0.0001), poor @entity5 cell differentiation (p = 0.04), and transfusion of more than 3 units of blood (p = 0.04) were independent adverse predictors of late survival. CONCLUSIONS: In addition to reaffirming the importance of completeness of resection and nodal involvement, this study demonstrates that blood transfusion (more than 3 units) may have a significant adverse effect on late survival after esophageal resection for @entity189 . Every effort should be made to limit the amount of transfused blood to the absolutely essential requirements.
