Intraoperative Blood Loss is a Critical Risk Factor for Peritoneal Recurrence After Curative Resection of Advanced Gastric Cancer
Intraoperative Blood Loss is a Critical Risk Factor for Peritoneal Recurrence After Curative Resection of Advanced Gastric Cancer
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DOI：
10.1007/s00268-009-9979-4
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发表时间：
2009-06-01
影响因子：
2.6
通讯作者：
Nagawa, Hirokazu
中科院分区：
文献类型：
--
作者：
Kamei, Takao;Kitayama, Joji;Nagawa, Hirokazu
在各种类型的恶性肿瘤中，围手术期输血已被证明与预后不良有关。我们回顾了146例进展期胃癌根治术患者的术中失血量和复发模式，并评估术中失血量与腹膜复发、局部复发和血源性复发的可能相关性。无论输血与否，发生腹膜复发的患者术中失血量明显多于无腹膜复发的患者。相反，失血与结节或血源性复发无关。多因素分析显示，大出血、手术可治愈性B和辅助化疗是进展期胃癌腹膜复发和预后不良的独立危险因素。进展期胃癌根治术中出血量与腹膜复发的发生有一定的相关性。外科医生必须记住，清洁和干燥的手术不仅可以减少胃癌患者30天的死亡率和发病率，还可以减少长期的腹膜复发。
Perioperative blood transfusion has been shown to be associated with poor outcome in various types of malignancy. However, the relationship between the amount of blood loss and specific types of cancer recurrence has not been documented.We retrospectively examined the amount of intraoperative blood loss and the recurrence pattern in 146 patients who underwent curative gastrectomy for advanced gastric cancer and assessed the possible correlation between intraoperative blood loss and peritoneal, locoregional, and hematogenous recurrences.The amount of intraoperative blood loss in patients who developed peritoneal recurrence was significantly greater than that in patients without peritoneal recurrence, irrespective of blood transfusion. In contrast, the blood loss was not associated with nodal or hematogenous recurrence. Multivariate analysis demonstrated that large blood loss as well as operative curability B and adjuvant chemotherapy were independent risk factors for peritoneal recurrence and a worse outcome in advanced gastric cancer.Intraoperative blood loss in curative gastrectomy for advanced gastric cancer may have a specific association with the development of peritoneal recurrence. Surgeons must remember that clean and dry surgery may lessen not only 30-day mortality and morbidity but long-term peritoneal recurrence in gastric cancer.