Effects of the combination of blood transfusion and postoperative infectious complications on prognosis after surgery for colorectal cancer

Background: The frequency of postoperative infectious complications is sign ificantly increased in patients with colorectal cancer receiving perioperat ive blood transfusion. It is still debated, however, whether perioperative blood transfusion alters the incidence of disease recurrence or otherwise a ffects the prognosis. Methods: Patient risk variables, variables related to operation technique, blood transfusion and the development of infectious complications were reco rded prospectively in 740 patients undergoing elective resection for primar y colorectal cancer. Endpoints were overall survival (n=740) and time to di agnosis of recurrent disease in the subgroup of patients operated on with c urative intention (n = 532). The patients were analysed in four groups divi ded with respect to administration or not of perioperative blood transfusio n and development or non-development of postoperative infectious complicati ons. Results: Overall, 19 per cent of 288 non-transfused and 31 per cent of 452 transfused patients developed postoperative infectious complications (P<0.0 01). The median observation period was 6.8 (range 5.4-7.9) years. In a mult ivariate analysis, risk of death was significantly increased among patients developing infection after transfusion (n=142) compared with patients rece iving neither blood transfusion nor developing infection (n=234): hazard ra tio 1.38 (95 per cent confidence interval (c.i.) 1.05-1.81). Overall surviv al of patients receiving blood transfusion without subsequent infection (n = 310) and patients developing infection without preceding transfusion (n = 54) was not significantly decreased. In an analysis of disease recurrence the combination of blood transfusion and subsequent development of infectio n (hazard ratio 1.79 (95 per cent c.i. 1.13-2.82)), localization of cancer in the rectum and Dukes classification were independent risk factors. Conclusion: Blood transfusion per se may not be a risk factor for poor prog nosis after colorectal cancer surgery. However, the combination of perioper ative blood transfusion and subsequent development of postoperative infecti ous complications may be associated with a poor prognosis.