The Prognostic Significance of Transfusion in Periampullary Cancer Following Pancreatoduodenectomy

ABSTRACT

PURPOSE: There are several reports that intraoperative transfusion may be a prognostic factor in periampullary cancer, but it is not conclusive. The purpose of this study is to clarify the prognostic significance of a transfusion following a pancreatoduodenectomy for periampullary cancers. METHODS: We analyzed 357 periampullary cancers from 1985 to 1997 (ampullary cancer 130 cases; distal bile duct cancer 141 cases; and pancreatic head cancer 86 cases). Analytic variables for possible prognostic factors were various clinicopathologic factors combined with the presence of the perioperative transfusion. RESULTS: Of the overall 357 patients, 215 (60%) have received an intraoperative transfusion. The 5-year survival rate of the 130 ampullary cancer patients was 59%, and 76 cases (58%) underwent an intra operative transfusion. The 5-year survival rate of patients without intraoperative transfusion was 79% whereas that of patients with a transfusion was 47% (p=0.029). Following multivariate analysis, an intraoperative transfusion was an independent prognostic factor in ampullary cancer (relative risk 2.174). In common bile duct cancer, the overall 5-year survival rate was 33%, and the 5-year survival rates of patients with (N=87) or without (N=54) a transfusion were 25% and 38% respectively, which showed a marginal statistical significance (p=0.0717). In pancreatic head cancer, the overall 5-year survival rate was 16% and there was no survival difference between transfused (N=52) and untransfused (N=34) patients. CONCLUSION: In the present study, intraoperative transfusion was an independent significant prognostic factor in ampullary cancer. Careful dissection to minimize intraoperative bleeding is mandatory in pancreatoduodenectomy for ampullary cancer.