T. Mynster et al., Effects of the combination of blood transfusion and postoperative infectious complications on prognosis after surgery for colorectal cancer, BR J SURG, 87(11), 2000, pp. 1553-1562
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.