Prognosis and postoperative lymphocyte count in patients with hepatocellular carcinoma who received intraoperative allogenic blood transfusion: A retrospective study

Sugita, S.; Sasaki, A.; Iwaki, K.; Uchida, H.; Kai, S.; Shibata, K.; Ohta, M.; Kitano, S.

doi:10.1016/j.ejso.2007.02.010

« Previous Next »European Journal of Surgical Oncology
Volume 34, Issue 3 , Pages 339-345, March 2008

Prognosis and postoperative lymphocyte count in patients with hepatocellular carcinoma who received intraoperative allogenic blood transfusion: A retrospective study

S. Sugita
- Department of Surgery, National Hospital Organization Miyazaki Hospital, 19403-4 Kawaminami-machi, Miyazaki 889-1301, Japan
- Department of Surgery I, Oita University Faculty of Medicine, 1-1 Hasama-machi, Oita, Yufu, 879-5593, Japan
A. Sasaki
- Department of Surgery, National Hospital Organization Miyazaki Hospital, 19403-4 Kawaminami-machi, Miyazaki 889-1301, Japan
- Department of Surgery I, Oita University Faculty of Medicine, 1-1 Hasama-machi, Oita, Yufu, 879-5593, Japan
- Corresponding author. Department of Surgery, National Hospital Organization Miyazaki Hospital, 19403-4 Kawaminami-machi, Miyazaki 889-1301, Japan. Tel.: +81 983 271 036; fax: +81 983 275 033.
K. Iwaki
- Department of Surgery I, Oita University Faculty of Medicine, 1-1 Hasama-machi, Oita, Yufu, 879-5593, Japan
H. Uchida
- Department of Surgery I, Oita University Faculty of Medicine, 1-1 Hasama-machi, Oita, Yufu, 879-5593, Japan
S. Kai
- Department of Surgery I, Oita University Faculty of Medicine, 1-1 Hasama-machi, Oita, Yufu, 879-5593, Japan
K. Shibata
- Department of Surgery I, Oita University Faculty of Medicine, 1-1 Hasama-machi, Oita, Yufu, 879-5593, Japan
M. Ohta
- Department of Surgery I, Oita University Faculty of Medicine, 1-1 Hasama-machi, Oita, Yufu, 879-5593, Japan
S. Kitano
- Department of Surgery I, Oita University Faculty of Medicine, 1-1 Hasama-machi, Oita, Yufu, 879-5593, Japan

Accepted 12 February 2007.

Abstract

Aims

The effect of perioperative blood transfusion on the survival of hepatocellular carcinoma (HCC) has not been fully investigated. To clarify the prognostic value of intraoperative allogenic blood transfusion, we conducted a comparative retrospective analysis of 224 patients with HCC who underwent hepatic resection.

Methods

We compared clinicopathologic background and survival after hepatic resection between patients who received intraoperative blood transfusion (n=101) and those who did not (n=123).

Results

Patients with blood transfusion had a larger tumor and more frequent vascular invasion than those without blood transfusion. The 5-year cancer-related survival rate after hepatic resection, but not the disease-free survival rate, was significantly lower in patients who underwent blood transfusion than in those who did not (38.3% vs. 66.7%, P<0.01). Multivariate analysis showed intraoperative blood transfusion (P=0.02), microscopic portal invasion (P<0.01), and preoperative serum alpha-fetoprotein elevation (P=0.03) to be independent risk factors for poor outcome after hepatic resection. The negative effect of blood transfusion on postoperative survival was observed only in patients with a tumor larger than 50mm in diameter. The absolute peripheral blood lymphocyte count on postoperative day 1 was significantly lower in patients who underwent blood transfusion (880/mm³) than in those who did not (1081/mm³) (P<0.01).

Conclusions

Our data suggest that intraoperative blood transfusion results in immunosuppression in the early postoperative period, allowing for progression of residual HCC after resection. Therefore, intraoperative allogenic blood transfusion should be avoided in patients with resectable HCC, particularly in those with a large tumor.

Keywords: Hepatocellular carcinoma, Blood transfusion, Hepatic resection, Prognosis