Impact of intraoperative blood loss on survival after curative resection for gastric cancer

doi:10.3748/wjg.v19.i33.5542

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Gastroenterol. Sep 7, 2013; 19(33): 5542-5550
Published online Sep 7, 2013. doi: 10.3748/wjg.v19.i33.5542

Table 1 Case characteristics n (%)

Characteristics	IBL (mL)			χ²	P value
Characteristics	< 200	200-400	> 400	χ²	P value
IBL (mean ± SD)	99.3 ± 25.0	223.2 ± 41.6	484.4 ± 179.9
Gender				4.307	0.116
Male	269 (70.2)	285 (71.6)	53 (71.8)
Female	114 (29.8)	113 (28.4)	11 (28.2)
Age (yr)				2.488	0.288
≤ 65	230 (60.1)	227 (57.0)	32 (50.0)
> 65	153 (39.9)	171 (43.0)	32 (50.0)
Tumor location				40.555	< 0.001
Lower 1/3	205 (53.5)	148 (37.2)	14 (21.9)
Middle 1/3	36 (9.4)	41 (10.3)	6 (9.4)
Upper 1/3	98 (25.6)	164 (41.2)	34 (53.1)
2/3 or more	44 (11.5)	45 (11.3)	10 (15.6)
Tumor size				17.677	< 0.001
< 5 cm	180 (47.0)	155 (38.9)	13 (20.3)
≥ 5 cm	203 (53.0)	243 (61.1)	51 (79.7)
Borrmann type				5.180	0.075
I/II	169 (44.1)	153 (38.4)	33 (51.6)
III/IV	214 (55.9)	245 (61.6)	31 (48.4)
Histology				0.982	0.612
Differentiated	121 (31.6)	139 (34.9)	21 (32.8)
Undifferentiated	262 (68.4)	259 (65.1)	43 (67.2)
Extranodal metastasis				1.963	0.375
Positive	59 (15.4)	71 (17.8)	14 (21.9)
Negative	324 (84.6)	327 (82.2)	50 (78.1)
Depth of invasion				14.719	0.023
pT1	14 (3.7)	11 (2.8)	0 (0.0)
pT2	53 (13.8)	44 (11.1)	0 (0.0)
pT3	21 (5.5)	28 (7.0)	6 (9.4)
pT4	295 (77.0)	315 (79.1)	58 (90.6)
Lymph node metastasis				15.793	0.015
pN0	173 (45.2)	146 (36.7)	19 (29.7)
pN1	56 (14.6)	82 (20.6)	9 (14.1)
pN2	85 (22.2)	87 (21.9)	15 (23.4)
pN3	69 (18.0)	83 (20.9)	21 (32.8)
TNM stage				15.313	0.004
I	53 (13.8)	43 (10.8)	0 (0.0)
II	132 (34.5)	118 (29.6)	19 (29.7)
III	198 (51.7)	237 (59.5)	45 (70.3)
Chemotherapy				2.036	0.361
Yes	104 (27.2)	119 (29.9)	14 (21.9)
No	279 (72.8)	279 (70.1)	50 (78.1)
Type of gastrectomy				37.357	< 0.001
Total	51 (13.3)	117 (29.4)	24 (37.5)
Subtotal	332 (86.7)	281 (70.6)	40 (62.5)
Combined organ resection				22.256	< 0.001
Yes	16 (4.2)	38 (9.5)	13 (20.3)
No	367 (95.8)	360 (90.5)	51 (79.7)
Extent of lymphadenectomy				7.230	0.027
D2 and D2+	189 (49.3)	188 (47.2)	20 (31.3)
D1	194 (50.7)	210 (52.8)	44 (68.8)
Postoperative complications				7.500	0.024
Present	20 (5.2)	34 (8.5)	9 (14.1)
Absent	363 (94.8)	364 (91.5)	55 (85.9)

IBL: Intraoperative blood loss; TNM: Tumour-node-metastasis.

Table 2 Survival analysis of all patients with gastric cancer

Characteristics	n (%)	5-yr OS	Univariate analysis		Multivariate analysis
Characteristics	n (%)	5-yr OS	χ²	P value	HR (95%CI)	P value
Gender			1.609	0.205
Male	607 (71.8)	42.20%
Female	238 (28.2)	47.10%
Age (yr)			21.037	< 0.001
≤ 65	489 (57.9)	50.10%			1 (ref)
> 65	356 (42.1)	34.60%			1.372 (1.140-1.652)	0.001
Tumor location			26.417	< 0.001
Lower 1/3	367 (43.4)	50.10%			1 (ref)
Middle 1/3	83 (9.8)	45.80%			0.978 (0.680-1.407)	0.905
Upper 1/3	296 (35.0)	39.50%			0.931 (0.741-1.169)	0.538
2/3 or more	99 (11.7)	29.30%			1.149 (0.832-1.586)	0.398
Tumor size			58.693	< 0.001
< 5 cm	348 (41.2)	57.80%			1 (ref)
≥ 5 cm	497 (58.8)	33.60%			1.411 (1.152-1.730)	0.001
Borrmann type			13.517	< 0.001
I/II	355 (42.0)	50.40%			1 (ref)
III/IV	490 (58.0)	38.60%			1.285 (1.062-1.556)	0.010
Histology			6.783	0.009
Differentiated	281 (33.3)	49.80%			1 (ref)
Undifferentiated	564 (66.7)	40.40%			1.151 (0.939-1.412)	0.176
Extranodal metastasis			52.773	< 0.001
Negative	701 (83.0)	47.50%			1 (ref)
Positive	144 (17.0)	24.30%			1.543 (1.236-1.925)	< 0.001
TNM stage			147.103	< 0.001
I	96 (11.4)	82.30%			1 (ref)
II	269 (31.8)	58.40%			2.253 (1.362-3.727)	0.002
III	480 (56.8)	27.50%			4.736 (2.898-7.740)	< 0.001
Chemotherapy			10.999	0.001
Yes	237 (28.0)	50.60%			1 (ref)
No	608 (72.0)	40.80%			1.357 (1.093-1.684)	0.006
Extent of lymphadenectomy			6.668	0.010
D2 and D2+	397 (47.0)	48.40%			1 (ref)
D1	448 (53.0)	39.30%			1.372 (1.126-1.671)	0.002
Type of gastrectomy			21.400	< 0.001
Subtotal	653 (77.3)	47.00%			1 (ref)
Total	192 (22.7)	31.80%			1.102 (0.849-1.430)	0.466
Combined organ resection			10.310	0.001
No	778 (92.1)	44.60%			1 (ref)
Yes	67 (7.9)	31.30%			1.116 (0.811-1.536)	0.501
Intraoperative blood loss			29.175	< 0.001
< 200 mL	383 (45.3)	51.20%			1 (ref)
200-400 mL	398 (47.1)	39.40%			1.242 (1.017-1.516)	0.033
> 400 mL	64 (7.6)	23.40%			1.590 (1.140-2.217)	0.006
Perioperative transfusion			6.145	0.013
No	634 (75.0)	45.70%			1 (ref)
Yes	211 (25.0)	37.00%			0.962 (0.748-1.180)	0.708
Postoperative complications			28.320	< 0.001
Absent	782 (92.5)	44.90%			1 (ref)
Present	63 (7.5)	27.00%			2.096 (1.525-2.881)	< 0.001

OS: Overall survival; TNM: Tumour-node-metastasis.

Table 3 Tumour-node-metastasis-stratified analysis of the overall survival

	Group 1¹		Group 2¹		Group 3¹		χ²	P value
	n	5-yr OS	n	5-yr OS	n	5-yr OS	χ²	P value
TNM
I	53	88.7	43	74.4			4.538	0.037
II	132	68.2	118	50.0	19	42.1	10.763	0.005
III	198	29.8	237	27.8	45	15.6	8.035	0.018

¹Group 1: IBL < 200 mL; Group 2: IBL 200-400 mL; Group 3: IBL > 400 mL. OS: Overall survival; TNM: Tumour-node-metastasis; IBL: Intraoperative blood loss.

Table 4 Association between clinicapothologic factors and the amount of intraoperative blood loss: univariate analysis

Characteristics	n (%)	Amount of IBL (mL) (mean ± SD)	t/F	P value
Gender			1.770	0.077
Male	607 (71.8)	191.4 ± 128.6
Female	238 (28.2)	175.2 ± 92.5
Age (yr)			-1.128	0.260
≤ 65	489 (57.9)	182.9 ± 121.8
> 65	356 (42.1)	192.3 ± 116.7
Tumor location			12.455	< 0.001
Lower 1/3	367 (43.4)	160.9 ± 87.8
Middle 1/3	83 (9.8)	179.5 ± 103.0
Upper 1/3	296 (35.0)	213.2 ± 127.5
2/3 or more	99 (11.7)	210.6 ± 177.5
Tumor size			-4.129	< 0.001
< 5 cm	348 (41.2)	166.7 ± 92.8
≥ 5 cm	497 (58.8)	200.9 ± 133.7
Borrmann type
I/II	355 (42.0)	187.5 ± 127.0	0.128	0.899
III/IV	490 (58.0)	186.4 ± 114.3
Histology			-0.160	0.873
Differentiated	281 (33.3)	185.9 ± 107.7
Undifferentiated	564 (66.7)	187.3 ± 125.3
Extranodal metastasis			-1.040	0.299
Negative	701 (83.0)	184.9 ± 119.7
Positive	144 (17.0)	196.3 ± 119.6
TNM stage			4.974	0.007
I	96 (11.4)	154.2 ± 67.1
II	269 (31.8)	183.3 ± 135.9
III	480 (56.8)	195.4 ± 117.1
Type of gastrectomy			-5.963	< 0.001
Subtotal	653 (77.3)	173.8 ± 102.3
Total	192 (22.7)	231.2 ± 158.1
Combined organ resection			-5.329	< 0.001
Absent	778 (92.1)	180.5 ± 110.9
Present	67 (7.9)	260.4 ± 180.0
Extent of llymphadenectomy			-2.676	0.008
D2 and D2+	397 (47.0)	175.2 ± 95.4
D1	448 (53.0)	197.2 ± 136.9
Year of surgery			-2.494	0.013
2003-2005	489 (57.9)	195.1 ± 133.6
2006-2007	356 (42.1)	174.3 ± 97.6

TNM: Tumour, node, metastasis; IBL: Intraoperative blood loss.

Table 5 Multivariate analysis of risk factors for intraoperative blood loss ≥ 200 mL

Feature		HR	95%CI	P value
Tumor location	Upper 1/3 and 2/3 or more vs lower and middle 1/3	1.717	1.272-2.317	< 0.001
Tumor size	≥ 5 cm vs < 5 cm	1.129	0.833-1.513	0.434
TNM stage	III vs I, II	1.174	0.872-1.580	0.290
Extent of gastrectomy	D1 vs D2 and D2+	1.161	0.860-1.566	0.330
Type of gastrectomy	Total vs subtotal	2.501	1.707-3.663	< 0.001
Combined organ resection	Present vs absent	1.996	1.089-3.659	0.025
Year of surgery	2003-2005 vs 2006-2007	1.452	1.080-1.954	0.014

TNM: Tumour, node, metastasis.

Citation: Liang YX, Guo HH, Deng JY, Wang BG, Ding XW, Wang XN, Zhang L, Liang H. Impact of intraoperative blood loss on survival after curative resection for gastric cancer. World J Gastroenterol 2013; 19(33): 5542-5550
URL: https://www.wjgnet.com/1007-9327/full/v19/i33/5542.htm
DOI: https://dx.doi.org/10.3748/wjg.v19.i33.5542