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Vol. 43. Issue 2.
Pages 63-72 (February 2020)
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Vol. 43. Issue 2.
Pages 63-72 (February 2020)
Original Article
DOI: 10.1016/j.gastre.2019.07.010
Impact of perioperative transfusions and sepsis on long-term oncologic outcomes after curative colon cancer resection. A retrospective analysis of a prospective database
Impacto de las trasfusiones y de las sepsis perioperatorias en los resultados oncológicos de largo plazo tras cirugía curativa de cáncer de colon. Análisis retrospectivo de una base prospectiva
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Gloria Baguenaa,, Gianluca Pellinoa,b,, Matteo Frassona,
Corresponding author
, Javier Escrigc, Franco Marinelloa, Alejandro Espíd, Alvaro García-Graneroa,e, Susana Rosellóf, Andres Cervantesf, Eduardo García-Graneroa
a Department of Colorectal Surgery, Hospital Universitario y Politécnico La Fe, University of Valencia, Spain
b Colorectal Surgery, Department of Medical, Surgical, Neurological, Metabolic and Ageing Sciences, Università della Campania “Luigi Vanvitelli”, Naples, Italy
c Hospital General de Castellón, Spain
d Department of General Surgery, Coloproctology Unit, Hospital Clínico Universitario, University of Valencia, Spain
e Department of Human Anatomy and Embryology, University of Valencia, Spain
f Department of Haematology and Medical Oncology, Hospital Clínico Universitario, University of Valencia, Spain
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Tables (5)
Table 1. Characteristics of patients (n=1277).
Table 2. Surgical and pathological characteristics.
Table 3. Postoperative morbidity and mortality.
Table 4. Multivariate analysis of variables associated with local recurrence and disease free survival: significant factors plus IASC, BT, and IASC+BT. HR>1 HR>1 is associated with increased risk of local or distant recurrence.
Table 5. Multivariate analysis of variables associated with cancer-specific survival. HR>1 associated with cancer-related mortality.
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Abstract
Objective

Intra-abdominal septic complications (IASC) affect short-term outcomes after surgery for colon cancer. Blood transfusions have been associated with worse short-term results. The role of IASC and blood transfusions on long-term oncologic results is still debated. This study aims to assess the impact of these two variables on survival after curative colon cancer resection.

Patients and methods

Retrospective analysis of a prospectively maintained database of patients who underwent curative surgery for colon cancer at a university hospital, between 1993 and 2010. Cox regression was used to identify the role of IASC and transfusions (alone and combined) on local recurrence (LR), disease-free survival (DFS), and cancer-specific survival (CSS).

Results

Out of the 1686 patients analyzed, 1277 fit in the inclusion criteria. Colorectal surgeons performed the procedure in 82.2% of the patients. Blood transfusions were administered to 25.8% of the patients. Thirty-day complication and mortality rates were 34.5% and 6.1%. IASC occurred in 9.9%. The mean follow-up was 66 months. The 5-year rates of LR, DFS, and CSS were 7%, 79.8%, and 85.1%. The year of surgery and pT (Hazard ratio 9.35, 95% CI 1.23–70.9, for T4) and pN (Hazard ratio 2.57, 95% CI 1.39–4.72, for N2) stages were independent risk factors for LR. The same variables, bowel obstruction and surgeries performed by surgeons not specialized in colorectal surgery, were also associated with worse DFS and CSS. IASC and blood transfusions were not associated with LR, DFS, and CSS, whether alone or combined.

Conclusions

IASC and transfusions were not associated with worse oncological outcomes after curative colon cancer surgery per se. Other factors were more important predictors of survival.

Keywords:
Colon cancer
Blood transfusion
Anastomotic leak
Complication
Survival
Local recurrence
Sepsis
Septic complications
Resumen
Objetivos

Las complicaciones sépticas intra-abdominales(CSIA) empeoran los resultados a corto plazo después de cirugía por cáncer de colon. Las trasfusiones de sangre también han sido relacionadas con peores resultados a corto plazo. El impacto de la CSIA y de las transfusiones en los resultados oncológicos es todavía debatido. Objetivo del presente estudio fue valorar el impacto de estas dos variables en la supervivencia de pacientes intervenidos por cáncer de colon.

Pacientes y métodos

Análisis retrospectivo de una base prospectiva de pacientes sometidos a cirugía curativa por cáncer de colon en un hospital universitario(1993-2010). Se utilizó regresión de Cox para valorar el efecto de CSIA y trasfusiones(aislados o en combinación) sobre recidiva local(RL), supervivencia libre de enfermedad(SLE) y supervivencia cáncer-especifica(SCE).

Resultados

De los 1686 pacientes analizados, se incluyeron 1277. La cirugía fue realizada por cirujanos colorrectales en el 82,2% de los pacientes. El 25,8% recibió transfusiones. Las tasas de complicaciones y mortalidad a los 30 días fueron del 34,5% y 6,1%. La frecuencia de CSIA fue del 9,9%. El seguimiento mediano fue de 66 meses. Las tasas a los 5 años de RL,SLE y SCE fueron 7%, 79,8% y 85,1%. El año de tratamiento, los estadios pT(Cociente de riesgo 9,35,IC95% 1,23-70,9,en T4)y pN(Cociente de riesgo 2,57,IC95% 1,39-4,72,en N2)resultaron como factores de riesgo para RL. Las mismas variables, la obstrucción intestinal y la cirugía realizada por cirujanos no colorrectales se asociaron también a peor SLE y SCE. CSIA y trasfusiones no resultaron asociadas con RL, SLE y SCE, ni de forma aislada ni combinadas.

Conclusiones

Las CSIA y trasfusiones no afectaron per se los resultados oncológicos de la cirugía de cáncer de colon. Otros factores resultaron más importantes predictores de supervivencia.

Palabras clave:
Cáncer de colon
Transfusión de sangre
Fuga anastomótica
Complicación
Supervivencia
Recurrencia local
Sepsis
Complicaciones sépticas

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