INTRODUCTION: The influence of preoperative
hemoglobin levels on outcomes of patients undergoing
esophagectomy for cancer is not clearly defined. The goal of this article was to explore the association between combined modality therapy, preoperative
anemia status, and perioperative
blood transfusion and risk of postoperative complications among patients undergoing esophageal resection. METHODS: From a retrospective esophageal database, 413 patients were identified.
Anemia was defined according to the World Health Organization classification of <13 g/dL or <12 g/dL for men or women, respectively.
Statistical analysis was performed with
analysis of variance, Pearson's chi(2), or
Fisher exact test as appropriate. The independent association of
anemia,
blood transfusion, and combined modality treatment on risk of postoperative complications were examined using multiple
logistic regression. RESULTS: Information on combined modality treatment, preoperative
hemoglobin levels, and
blood transfusion was available for 413 patients, of whom 57% received combined modality treatment. Overall 197 (47.6%) patients were preoperatively found to be
anemic, and those who had received combined modality treatment were more likely to be
anemic (60.6% versus 30.7%, P < 0.001).
Anemic patients required more
blood transfusions than nonanemic patients (46.7% versus 29.6%, P < 0.001). Seventy-five percent of patients who required
transfusion during the hospital stay had received combined modality treatment (P = 0.01). Combined modality treatment and
anemia were not associated with increased risk of complications. Patients with any perioperative complication and
surgical site
infections were more likely to have received
blood transfusion compared to patients without complications (OR = 1.73; 95% CI 1.04-2.87 and OR = 2.98; 95% CI 1.04-8.55; respectively). CONCLUSIONS: Overall, we determined that administration of
neoadjuvant treatment to
esophageal cancer patients was not associated with an increased rate of perioperative complications. Preoperative
anemia did not predict worsened short-term outcomes, but increased the chances of
red blood cell transfusion, which were significantly associated with higher overall complications and increased risk of
surgical site
infections. These data confirm previous studies that allogenic
red blood cell transfusions are independent
risk factors for increased
morbidity and mortality and should be minimized during
surgery for
esophageal cancer.
