Risk factors for perioperative allogenic blood transfusion and its impact on early recurrence after cytoreductive surgery with or without intraperitoneal hyperthermic chemotherapy.

Abstract

Background: Allogenic blood transfusion (ABT) is associated with postoperative complications and possibly early recurrence (ER). after oncologic surgery. We sought to investigate predictors and impact of ABT in cytoreductive surgery (CRS) with or without hyperthermic intraperitoneal chemotherapy (HIPEC).

Methods: All patients who underwent CRS±HIPEC from June 2020 to January 2022 at a high-volume center were included. Patients were classified according to whether they had received a perioperative ABT during the entire hospitalization period. ER was defined as the time from complete resection to the first recurrence (local or distant) or death, whichever occurred first, within 2 years after surgery. Multivariate logistic regression and Cox analysis identified risk factors for ABT and ER, respectively.

Results: Of 168 patients, 56 (33.3%) required ABT (mean 2.4 [2.2] red blood cell units). Multivariate logistic analysis showed that hemoglobin levels 24-h before surgery (odds ratio [OR] 0.5; 95% confidence interval [CI]: 0.4 to 0.7), intraoperative fluid balance (OR 1.01; 95% CI: 1.01 to 1.02) and time of surgery (OR 1.1; 95% CI: 1.1 to 1.1) were independently associated with ABT. Multivariate Cox regression identified time of surgery (hazard ratio [HR] 1.01, 95% CI: 1.01 to 1.02) and previous systemic chemotherapy (HR 2.5, 95% CI: 1.3 to 4.8) as risk factors for ER, while ABT was not (P=0.078).

Conclusions: Lower preoperative hemoglobin levels, higher intraoperative fluid balance, and longer surgery time are risk factors for ABT. Longer operative time and previous systemic chemotherapy are associated with early recurrence.