0091 Endo+Colon
PERIOPERATIVE BLOOD TRANSFUSION IN PATIENTS WITH
COLORECTAL CANCER WHO UNDERWENT SURGERY
Sibirsky Ohn1, Avrutis Oleg1, Meshoulam Jack1, Michalevsky Vladimir1,
Durst Arie1, Almagor Miriam2 - Department of Surgery1 and Division of
Clinical Laboratories2, Bikur Cholim Hospital, Jerusalem.
Background: Several reports claimed that perioperative blood transfusions
promote recurrence of cancer after surgery and are generally correlated with
poor prognosis and other disadvantages. The purpose of the present study was
to evaluate the indications for pre- and postoperative blood transfusion in
patients with colorectal (CR) cancer (CRC) that underwent surgery.
Material and Methods: We have retrospectively evaluated 100 consecutive
patients who underwent resection of tumors of the digestive tract during the
years 2000-2003 at Bikur Cholim Hospital. The study group included 10
patients that underwent emergency operation and 54 patients admitted electively
due to colorectal cancer. The control group consisted of 18 patients (11
emergencies and 7 electives) with benign colorectal pathology and 14 patients
with gastric carcinoma. Four patients were excluded from the study due to
perioperative death, after emergency operation. The operative procedures were
either open colectomies (OC) or Hand-Assisted Laparoscopic Colectomies
(HALC) for CRC and gastrectomies for gastric cancers.
Results: Fifty five percent of the patients with CRC presented with bleeding,
weakness and anemia (hemoglobin 6.8-9.3 mg/dL). A third of these patients
received perioperative blood transfusion (mean of 2 packed cells per patient).
Fifty percent of the patients that received blood had ischemic heart disease. Of
the control group, 56% presented with anemia or upper GI bleeding and they all
received blood (mean of 3.25 packed cells per patient). Among the elective
operations for CRC, 12 out of 40 OC patients (30%) (received an average of
2.83 x PC per patient) compared to only 1 out of 14 HALC patients (7%)
(received an average of 3 x PC per patient). Among the elective operations for
benign CR disease non of the 5 HALC patients received blood transfusions
compared to 50% of the open procedures (received 3 x PC per patient).
Conclusions: Despite of the general recommendations to avoid blood
transfusion in patients with colorectal cancer, in practice the physiological
instability of most emergency patients and one third of the elective open
colectomies required actually administration of blood. If blood transfusion was
indicated than similar quantities of blood were given to all study groups. HALC
was associated with less perioperative blood consumption. Autodonation of
blood is a relevant option concerning at least one forth of the elective patients.
The above trends should be investigated farther in a large scale prospective
randomized studies.