The Relationship between Perioperative Blood Transfusion and Prognosis in Stomach Cancer

PURPOSE: Perioperative blood transfusion and its influence on the immune system in cancer surgery is a subject of controversy. We made a retrospective study to comprehend the prognostic effects of perioperative blood transfusion in gastric cancer surgery. METHODS: A total 284 patients who underwent gastrectomy for gastric cancer from 1991 to 1998 were retrospectively reviewed. Uni- and multi-variated analyses of the incidence and amount of perioperative blood transfusion were performed, along with a comparison of the clinicopathologic features. RESULTS: Of the 284, 119 (42%) required no blood transfusion and 165 (58%) required blood transfusion within the perioperative period. The transfused group included patients with larger tumors (more than 4 cm, 67.1% vs 47.5%, P=0.001), with longer operation time (260.8 vs 229.2 min, P=0.001), with total gastrectomy (29.7% vs 14.4%, P=0.001), with advanced T-stages (P=0.001), and with more advanced nodal metastasis (P=0.005) than the nontransfused group. Overall comparison of transfused patients versus nontransfused patients by log rank analysis revealed a statistically significant adverse influence of blood transfusion on survival rate (58.7% vs 80.3%, P=0.001). However, after stratifying patients into stages and applying Cox-regression analyses, blood transfusion did not appear to have any effect on prognosis except stage III. CONCLUSION: We could not find any direct causal relationship between perioperative transfusion and long term prognosis in patients receiving gastric cancer surgery. However, in cases with advanced gastric cancer, it is better to refrain from unnecessary blood transfusion in the perioperative periods.

Porto-Mesenteric Venous Thrombosis

Porto-mesenteric venous thrombosis is a rare disorder, which can occur as a complication of many diseases. Porto-mesenteric venous thrombosis leads to venous hypertension, outpouring of blood into the bowel lumen and mesentery, distension and rupture of venules, and hemorrhgae and edema of the bowel wall. In cases of mild porto-mesenteric venous thrombosis, nonoperative management-consisting of fluid resuscitation, anticoagulation, and thrombolysis-may be acceptable in clinically stable patients with early diagnosis. If patients show clinical signs of peritonitis or deteriorates on medical management, prompt surgical intervention is warranted. At laparotomy, segmental resection of the involved bowel with primary anastomosis is easily accomplished, because the hemorrhagic infarction associated with porto-mesenteric venous thrombosis is limited. The optimal duration of anticoagulation therapy has not been defined. However, recommendation is that anticoagulation should be continued indefinitely, as it reduces the incidence of porto-mesenteric venous thrombosis recurrence. The patient in our study presented with a severely edematous duodenum and proximal jejunum in CT scan with signs of peritonitis due to perforation of the upper-jejunum. We had performed a percutaneous drainage for intraabdominal abscess which occurred the jejunal infarction. About 1 month later, a resection of a well-controlled fistula tract was done.

The Prognostic Significance of Immunohistochemically Detected Isolated Tumor Cells in Lymph Node in Colorectal Cancer

PURPOSE: Metastasis of a colorectal carcinoma to regional lymph nodes indicates poor prognosis. The detection of lymph node metastasis is routinely performed by his topathological analysis of hematoxylin-eosin (H&E) stained sections. However the routine histological technique may fail to detect isolated tumor cells in lymph nodes. The aims of this study are to elucidate the prognostic significance of the presence of isolated tumor cells in the regional lymph nodes in colorectal cancer, and to elucidate the correlation between the presence of isolated tumor cells and p53 protein expression in the primary colorectal cancer tissue. METHODS: We used immunohistochemical staining with anti-cytokeratin antibody to examine 452 lymph nodes in 24 patients (11 recurrent and 13 nonrecurrent) who were histologically determined Astler-Coller B. And we used immunohistochemical staining with p53 protein to examine primary colorectal cancer tissues of the patients. RESULTS: Immunohistochemical staining of cytokeratin revealed the presence of isolated tumor cells in 5/13 patients (38.5%), 5/214 lymph nodes (2.34%) in the nonrecurrent group and 6/11 patients (54.6%), 11/244 lymph nodes (4.51%) in the recurrent group, respectively. The detection rate of isolated tumor cells in the recurrent group was slightly higher than nonrecurrent group, but the difference was not significant statistically. The expression rate of p53 protein was 23.1% (3/13) in the nonrecurrent group and 36.4% (4/11) in the recurrent group, respectively. The expression rate of the p53 protein was not significantly correlated with the presence of isolated tumor cells in regional lymph nodes and the rate of tumor recurrence. CONCLUSIONS: The presence of isolated tumor cells in regional lymph nodes was not a prognostic indicator in predicting recurrence in histologically determined Astler- Collar B colorectal cancer patients.