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Stage-by-stage analysis of the effect of blood transfusion on survival after curative hepatectomy for hepatocellular carcinoma—a retrospective study

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Abstract

Objective

This study is to examine the impact of perioperative (intraoperative/postoperative) blood transfusion on the outcomes of curative hepatectomy for hepatocellular carcinoma.

Summary background data

Hepatectomy is a well-established curative treatment for hepatocellular carcinoma, and blood transfusion cannot always be avoided in treating the disease.

Methods

A retrospective study of patients having curative hepatectomy for hepatocellular carcinoma from January 2010 to December 2019 at a single center was conducted. The patients were stratified by their disease stage. Patients with and without perioperative blood transfusion were matched by propensity-score matching and compared for each disease stage. Univariate and multivariate analyses were performed to identify prognostic factors for overall survival for each stage.

Results

A total of 846 patients were studied. Among them, 125 received perioperative blood transfusion and 720 did not. Patients with blood transfusion had worse disease-free and overall survival. After stratification and matching, the ratios of transfusion to non-transfusion were 33:165 (stage 1), 28:140 (stage 2), and 45:90 (stage 3). Perioperative blood transfusion was associated with a higher incidence of postoperative complications in all three disease stages (p = 0.004/0.006/0.017), and hence longer hospitalization (p < 0.001 in all stages), but had no significant impact on hospital mortality (p = 0.119/0.118/0.723), 90-day mortality (p = 0.259/0.118/0.723), disease-free survival (p = 0.128/0.826/0.511), or overall survival (p = 0.869/0.122/0.122) in any disease stage. Prognostic factors for overall survival included tumor size, tumor number, alpha-fetoprotein level, and postoperative complication of grade ≥ 3A.

Conclusion

Perioperative blood transfusion was associated with a higher incidence of complications but had no significant impact on survival after curative hepatectomy for hepatocellular carcinoma.

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Data availability

No datasets were generated or analyzed during the current study.

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Authors and Affiliations

  1. Department of Surgery, School of Clinical Medicine, University of Hong Kong, 102 Pok Fu Lam Road, Hong Kong, China

    Wong Hoi She, Simon Hing Yin Tsang, Wing Chiu Dai, Albert Chi Yan Chan, Chung Mau Lo & Tan To Cheung

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Contributions

She WH prepared the raw data, statistical analysis, drafted, and wrote the main manuscript text. Tsang SHY and Dai WC prepared the raw data. Chan ACY, Lo CM, and Cheung TT supervised the project. All authors reviewed the manuscript.

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Correspondence to Wong Hoi She.

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Mini-abstract

A stage-by-stage analysis of intraoperative and postoperative blood transfusion in patients with curative hepatectomy for hepatocellular carcinoma after propensity-score matching showed that blood transfusion was associated with a higher incidence of postoperative complications in all three disease stages but had no significant impact on survival in any disease stage.

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She, W.H., Tsang, S.H.Y., Dai, W.C. et al. Stage-by-stage analysis of the effect of blood transfusion on survival after curative hepatectomy for hepatocellular carcinoma—a retrospective study. Langenbecks Arch Surg 409, 83 (2024). https://doi.org/10.1007/s00423-024-03278-z

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