Prognosis and postoperative lymphocyte count in patients with hepatocellular carcinoma who received intraoperative allogenic blood transfusion: A retrospective study
Introduction
Hepatocellular carcinoma (HCC) is common worldwide. HCC is frequently accompanied by chronic hepatitis or liver cirrhosis related to hepatitis B virus or hepatitis C virus (HCV) infection, and most patients have poor liver function reserve. Particularly in patients with HCC accompanied by liver cirrhosis, the platelet count and peripheral blood prothrombin time are decreased, and the risk of hemorrhage is increased. Surgical treatment has been considered the most effective therapy for large HCC tumors.1 However, even such surgical techniques as hepatic pedicle clamping2 and predissected liver ablation3 often involve perioperative blood transfusion.
Despite recent progression in surgical techniques and postoperative management, the recurrence rate after surgical resection of HCC is high.4 Intrahepatic recurrence of HCC is due to either intrahepatic metastasis or multicentric cancer development.5 HCC cells frequently invade the portal vein and form intrahepatic metastases. Vascular invasion of HCC cells increases with tumor size.6, 7 Therefore, it has been suggested that anatomic resection may improve the survival of patients with large HCC.8 Postoperative adjuvant chemotherapy, such as intrahepatic arterial infusion, may also improve survival after hepatic resection.9 However, tumor cells often remain in the liver after hepatic resection.
Several recent studies have shown that perioperative blood transfusion has an adverse effect on postoperative outcome after resection for some types of malignant tumor.10 Although the mechanism remains unclear, several investigators have suggested that allogenic blood transfusion may induce immunosuppression.11, 12 Several reports have shown that natural killer cell11, 12 and/or helper T-cell activities are decreased and that suppressor T-cell activity is increased after allogenic blood transfusion.13 With respect to HCC, some investigators have reported that perioperative allogenic blood transfusion decreases the long-term survival rate after resection.14, 15 Asahara et al. reported that perioperative allogenic blood transfusion decreased survival after resection only in patients with stage I or II HCC.16 However, Kwon et al. reported no effect of perioperative blood transfusion on survival after hepatic resection.17 Therefore, the effect of perioperative allogenic transfusion in patients with HCC remains unclear. To clarify the effect of intraoperative allogenic blood transfusion on long-term survival of patients with HCC, we retrospectively investigated the relation between intraoperative allogenic blood transfusion and survival of patients with HCC, with a focus on tumor size.
Section snippets
Patients
During the period February 1983 through January 2005, 259 patients with HCC underwent curative hepatic resection at the Department of Surgery I, Oita University Faculty of Medicine, Oita, Japan. Of these patients, 20 who died of complications within 30 days after surgery, 9 for whom postoperative outcome was uncertain, and 6 for whom the tumor was shown to be completely necrotic were excluded from the present study. Therefore, 224 patients were included. We defined curative resection according
Patient characteristics
The patient group comprised 172 men and 52 women. Mean age at the time of hepatic resection was 63.2 years (range, 36–84 years). Serum HCVAb test results were positive in 114 of the 177 patients tested. Mean greatest tumor dimension was 48.8 mm (median, 40 mm; range, 5–186 mm). Mean and median preoperative serum AST levels were 66.9 IU/l and 54 IU/l, respectively; AFP levels were 2860 ng/ml and 39 ng/ml, respectively. One hundred nineteen patients underwent hepatic resection of less than
Perioperative blood transfusison and prognosis
Adverse effects on survival have been reported for perioperative blood transfusion after resection for several types malignant tumors such as cancer of the stomach,19 esophagus,20 colorectum,21 lung,22 pancreas,23 periampullary region,24 and bile duct.25 Watering et al. reported that perioperative allogenic blood transfusion was associated with decreased survival but not with recurrence of colorectal cancer.26 With respect to HCC, several investigators have reported that perioperative blood
References (36)
- et al.
Radiofrequency-assisted liver resection
J Gastrointest Surg
(2003) - et al.
Predictors of microvascular invasion in patients with hepatocellular carcinoma who are candidates for orthotopic liver transplantation
J Gastrointest Surg
(2002) - et al.
Diminished helper/suppressor lymphocyte ratios and natural killer activity in recipients of repeated blood transfusion
Blood
(1984) - et al.
Association of perioperative transfusions with poor outcome in resection of gastric adenocarcinoma
Am J Surg
(1994) - et al.
The influence of perioperative blood transfusion on survival after esophageal resection for carcinoma
Ann Thorac Surg
(2002) - et al.
The influence of blood transfusion on survival in operated non-small cell lung cancer patients
J Thorac Cardiovasc Surg
(2003) - et al.
Prognostic factors of surgical resection in middle and distal bile duct cancer: an analysis of 55 patients concerning the significance of ductal and radial margins
Surgery
(2005) - et al.
Suppression of cellular immunity by surgical stress
Surgery
(2000) - et al.
Long-term outcome of resection of large hepatocellular carcinoma
Br J Surg
(2006) - et al.
Selective hepatic vascular exclusion versus Pringle maneuver in major liver resections: prospective study
World J Surg
(2003)