Y. Nakaseko1, K. Haruki1, H. Shiba1, Y. Takano1, S. Onda1, F. Suzuki1, M. Matsumoto1, T. Sakamoto1, T. Gocho1, Y. Ishida1, K. Yanaga1 1The Jikei University School Of Medicine,Department Of Surgery,Nishi-Shinbashi, MINATO-KU, TOKYO, Japan
Background: Blood transfusion has been reported to be associated with immunomodulation and poor oncologic outcomes in several malignancies. The aim of the study was to investigate the influence of the use of fresh frozen plasma (FFP) on long-term outcomes in patients with colorectal liver metastases (CRLM) after hepatic resection.
Patients and
Methods: The study comprised 127 patients who had undergone elective hepatic resection for CRLM between April 2000 and December 2013. We retrospectively investigated the influence of the use of FFP on recurrence-free survival as well as and overall survival and assessed impact on postoperative markers of inflammation.
Results: In multivariate analysis, more than 4 lymph node metastases of the primary cancer (p=0.001), bilobar distribution (p=0.002), and perioperative FFP transfusion (p=0.005) were independent risk factors for cancer recurrence, while more than 4 lymph node metastases of the primary cancer (p<0.001), presence of neo-adjuvant chemotherapy (p=0.002) and perioperative FFP transfusion (p=0.004) were independent risk factors for poor overall survival. In patients with FFP transfusion, tumor size (p = 0.004), anatomical resection (p<0.001), duration of operation (p = 0.039) and intraoperative blood loss (p < 0.001) were significantly greater. Moreover, FFP transfusion was associated with higher white blood cell level on postoperative day 3 (p<0.001) and 5 (p=0.010), and lower serum C-reactive protein level on postoperative day 3 (p<0.001) and 5 (p=0.017).
Conclusion: Perioperative FFP transfusion is independently associated with poor long-term outcomes in patients with CRLM after hepatic resection. FFP may have influence on postoperative inflammation by its immunosuppressive effect.