Elsevier

Surgery

Volume 127, Issue 2, February 2000, Pages 185-192
Surgery

Original Communications
Usefulness of autologous blood transfusion for avoiding allogenic transfusion and infectious complications after esophageal cancer resection*

https://doi.org/10.1067/msy.2000.102048Get rights and content

Abstract

Background: A retrospective investigation was conducted to determine whether autologous blood collection could reduce allogenic transfusion after resection of esophageal cancer and whether allogenic transfusion influenced postoperative infection. Methods: Patients (n = 100) who met the criteria for hemoglobin, age, body weight, and serum protein donated 800 mL of autologous blood from May 1994 to December 1997. The control group (n = 248) was selected from patients who met the same criteria and did not donate autologous blood over the 10 years before the start of autologous blood collection. Results: Only three patients (3%) from the autologous group required allogenic transfusion versus 84 patients (33.7%) from the control group. Sixteen of the 26 patients who received more than 4 units of allogenic blood contracted postoperative infections compared with 25 of 165 patients who did not (P <.0001). Autologous blood transfusion significantly increased the probability of avoiding allogenic transfusion (odds ratio, 27.58), and allogenic transfusion was significantly related to postoperative infection (odds ratio, 1.19), according to logistic regression analysis. Conclusions: Autologous blood collection reduces the need for allogenic transfusion in patients undergoing resection of esophageal cancer, and avoidance of allogenic transfusion may reduce the risk of postoperative infection.(Surgery 2000;127:185-92.)

Section snippets

Patient selection

We retrospectively reviewed the medical records of 508 patients who underwent esophagectomy for esophageal cancer at the Department of Surgery of Toranomon Hospital between January 1984 and December 1997. All patients were evaluated before treatment by means of a history and a physical examination, as well as chest roentgenography, endoscopy, barium esophagography, computed tomography, and ultrasonography. All had biopsy-proven squamous cell carcinoma of the esophagus. Eighty-eight patients who

Results

A total of 105 patients were enrolled in the ABT group. Five patients (4.8%) were excluded because only 400 mL of autologous blood was collected. There were no side effects of phlebotomy with the administration of rHuEPO and ferric pyrophosphate. Although operative blood loss was similar in the two groups, significantly fewer patients from the ABT group required allogenic blood transfusion compared with those from the control group. Only three patients (3%) from the ABT group received allogenic

Discussion

Transfusion-mediated immunosuppression in cancer-bearing hosts was initially studied through animal experiments rather than clinically. Francis et al12 reported that allogenic transfusion was followed by depression of in vitro lymphocyte reactivity to antigenic and mitogenic stimuli as well as an increase of lymphocyte suppressive activity in the plasma. Clarke et al13 suggested that the growth rate of the primary tumor was not altered by transfusing animals with allogenic blood, but

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    *

    Reprint requests: Yoshihiro Kinoshita, MD, Department of Surgery, Toranomon Hospital, 2-2-2, Minato-ku, Toranomon, Tokyo, 105-8470, Japan.

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