Impact of Autologous Blood Transfusion on Survival and Recurrence among Patients Undergoing Partial Hepatectomy for Colorectal Cancer Liver Metastases.

ABSTRACT

BACKGROUND: Autologous transfusion (AT) has long been considered unsafe in major oncologic operations due to a theoretic risk of spreading metastatic disease, however, few data support this assumption. STUDY DESIGN: We conducted a retrospective analysis of 147 patients who underwent partial hepatectomy for colorectal cancer metastases at a single institution. Seventy-four patients received AT only and 73 received no transfusion (NT). We compared the overall survival and recurrence-free survival of these groups using Kaplan-Meier survival curves and adjusted hazard ratios. RESULTS: Patients who received AT had greater blood loss, more extensive resections, and longer procedure times. There were no differences in age, sex, proportion colon vs rectal cancer, or Fong Clinical Risk Score. Mean follow-up was 54 months. Median overall survival in the AT group was 59 months compared with 54 months in the NT group (p = 0.69) on log-rank test. No difference in overall survival was noted after adjusting for age, sex, Fong score, type of cancer (colon vs rectal), receipt of neoadjuvant therapy, receipt of adjuvant therapy, extent of resection and blood loss (hazard ratio AT vs NT 0.58; 95% CI 0.31 to 1.11; p = 0.10). Recurrence-free survival was also similar in the AT and NT groups (27% vs 37%; p = 0.22). The adjusted hazard ratio for recurrence-free survival was 0.95 (95% CI 0.54 to 1.65; p = 0.85). CONCLUSIONS: Autologous blood transfusion is not associated with an increased recurrence risk or a higher mortality rate. Surgeons performing liver resections for patients with colorectal cancer metastases can safely transfuse filtered autologous blood.