Perioperative transfusion: Is it a real prognostic factor of periampullary cancer following pancreatoduodenectomy?

Introduction: We analyzed our data to clarify the prognostic significance of transfusion (preoperative, intraoperative, postoperative) following PD for periampullary cancers. Methods: We analyzed 252 periampullary cancers treated by PD from 2001 to 2010 (pancreatic cancer 125 cases, bile duct cancer 71 cases, ampullary cancer 56 cases) in National Cancer Center, Korea. Results: A total of 120 (48%) of the 252 patients have received perioperative; altogether, 48 patients (19%) underwent intraoperative transfusion transfusion (preoperative 5%, postoperative 37%). The 5-year survival rate of 252 periampullary cancer patients was 31%. The 5-year survival rate of patients without perioperative transfusion was 36%, whereas that of patients with a transfusion was 25% (p = 0.005). Following multivariate analysis, perioperative transfusion, intraoperative transfusion, postoperative transfusion were found to be independent prognostic factors for those with periampullary cancer. Among those with pancreatic cancer, the overall 5-year survival rate was 19%, and the 5-year survival rates for patients with (n = 66) or without (n = 59) transfusion were 17% and 21% (p = 0.106). For those with bile duct cancer, there was no survival difference between transfused (n = 34) and untransfused (n = 37) patients. But preoperative transfusion, intraoperative transfusion were independent risk factors for prognosis of patients with bile duct cancer following PD. In ampullary cancer, lastly, there was no survival difference between transfused (n = 20) and untransfused (n = 36) patients. And there was no significant relation between transfusion and disease prognosis after resection. Conclusions: For patients with periampullary cacner, minimization of perioperative bleeding may be mandatory.