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World J Gastroenterol. Jun 14, 2019; 25(22): 2743-2751
Published online Jun 14, 2019. doi: 10.3748/wjg.v25.i22.2743
Long-lasting discussion: Adverse effects of intraoperative blood loss and allogeneic transfusion on prognosis of patients with gastric cancer
Koki Nakanishi, Mitsuro Kanda, Yasuhiro Kodera
Koki Nakanishi, Mitsuro Kanda, Yasuhiro Kodera, Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
Author contributions: All authors equally contributed to this paper with respect to the conception and design of the study; literature review and analysis; drafting, critical revision, and editing; and approval of the final version.
Conflict-of-interest statement: No potential conflicts of interest. No financial support.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Mitsuro Kanda, MD, PhD, Doctor, Research Fellow, Surgeon, Surgical Oncologist, Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan. m-kanda@med.nagoya-u.ac.jp
Telephone: +81-52-7442249 Fax: +81-52-7442252
Received: March 12, 2019
Peer-review started: March 13, 2019
First decision: March 27, 2019
Revised: March 29, 2019
Accepted: April 19, 2019
Article in press: April 19, 2019
Published online: June 14, 2019
Processing time: 95 Days and 0.6 Hours
Abstract

Gastrectomy with radical lymph node dissection is the most promising treatment avenue for patients with gastric cancer. However, this procedure sometimes induces excessive intraoperative blood loss and requires perioperative allogeneic blood transfusion. There are lasting discussions and controversies about whether intraoperative blood loss or perioperative blood transfusion has adverse effects on the prognosis in patients with gastric cancer. We reviewed laboratory and clinical evidence of these associations in patients with gastric cancer. A large amount of clinical evidence supports the correlation between excessive intraoperative blood loss and adverse effects on the prognosis. The laboratory evidence revealed three possible causes of such adverse effects: anti-tumor immunosuppression, unfavorable postoperative conditions, and peritoneal recurrence by spillage of cancer cells into the pelvis. Several systematic reviews and meta-analyses have suggested the adverse effects of perioperative blood transfusions on prognostic parameters such as all-cause mortality, recurrence, and postoperative complications. There are two possible causes of adverse effects of blood transfusions on the prognosis: Anti-tumor immunosuppression and patient-related confounding factors (e.g., preoperative anemia). These factors are associated with a worse prognosis and higher requirement for perioperative blood transfusions. Surgeons should make efforts to minimize intraoperative blood loss and transfusions during gastric cancer surgery to improve patients’ prognosis.

Keywords: Gastric cancer; Blood loss; Prognosis; Transfusion; Adverse effect; Immunosuppression; Mortality; Recurrence; Complication

Core tip: Whether perioperative blood loss or blood transfusion has adverse effects on the prognosis in patients with gastric cancer remains unclear. We reviewed laboratory and clinical evidence of this association in patients with gastric cancer. A large amount of clinical evidence revealed that excessive intraoperative blood loss and blood transfusion have adverse effects on the prognosis. The possible mechanisms underlying the association between intraoperative blood loss and a poor prognosis are immunosuppression, unfavorable postoperative conditions, and tumor cell spillage into the pelvis, and those underlying the association between blood transfusions and a poor prognosis are immunosuppression and preoperative anemia.