Storage time of transfused blood and disease recurrence after colorectal cancer surgery

BACKGROUND: Perioperative blood transfusion and subsequent development of p ostoperative infectious complications may lead to poor prognosis of patient s with colorectal cancer, It has been suggested that the development of pos toperative infectious complications may be related to the storage time of t he transfused blood. Therefore, we studied the relationship between blood s torage time and the development of disease recurrence and long-term surviva l after colorectal cancer surgery. METHODS: Preoperative and postoperative data were prospectively recorded in 740 patients undergoing elective resect ion for primary colorectal cancer. None of the patients received preoperati ve or postoperative chemotherapy or radiation therapy. Endpoints were overa ll survival and disease recurrence in the subgroup of patients operated on with curative intention who also survived the first 30 days after operation . Storage of huffy-coat-depleted red cells suspended in saline, adenine, gl ucose, and mannitol blood for 21 days was used as cut-off point. RESULTS: M edian follow-up was 6.8 years (range, 5.4 years to 7.9 years), and median o verall survival was 4.6 years for 288 nontransfused patients and 3.0 years for 452 transfused patients (P = 0.004). The survival of patients receiving blood exclusively stored < 21 days was 2.5 years. For patients receiving a lly blood stored greater than or equal to 21 days, survival was 3.7 years ( P = 0.12), Among patients with. curative resection (n = 532), the hazard ra tio of disease recurrence was 1.5 (95 percent CI; 1.1 to 2.2) and 1.0 (95 p ercent CI; 0.7 to 1.4) in the two transfused groups, respectively, compared with the nontransfused group after multivariable correction for patient ag e, gender, colonic/rectal tumor localization, Dukes classification, blood l oss, and postoperative infectious complications. CONCLUSION: Transfusion of buffy-coat-depleted red cells suspended in saline, adenine, glucose, and m annitol blood stored for < 21 days may be an independent risk factor for de velopment of recurrence after elective colorectal cancer surgery.