Blood transfusion is associated with worse outcomes following pancreatic resection for pancreatic adenocarcinoma

Background: Pancreatectomy remains the only potentially curative therapy for patients with pancreatic ductal adenocarcinoma (PDAC). Existing literature reports that 27-68% of patients require perioperative allogeneic blood transfusion (PBT). An historical practice of liberal PBT use is being questioned as data emerges documenting a detrimental long-term oncologic effect. The impact of transfusion in an era of restrictive PBT is incompletely described. Methods: Single-institution, prospectively maintained databases identified 546 patients who underwent resection for PDAC from 2009 to 2015. Patients were stratified by PBT and clinicopathological variables and outcomes were analyzed by multivariable Cox regression to determine risk-adjusted hazard ratios (HR). Results: The 238 patients (43.0%) who received PBT, were more likely to be elderly or have a history of coagulopathy and anemia. PBT was also more common with rising American Society of Anesthesiologist (ASA) class, neoadjuvant therapy, higher estimated blood loss, positive margins, and need for vascular resection. The median overall survival (OS) for the entire cohort was 24.8 months. PBT was associated with a poorer median OS (17.2 vs. 27.4 months, P<0.001). On multivariable analysis, PBT was independently associated with poorer OS (HR =1.45, P=0.006). Receipt of two or more blood units was associated with a shorter survival (15.9 vs. 26.8 months, P<0.001). Conclusions: Patients are more apt to require PBT with increasing comorbidities, locally-advanced/borderline-resectable tumors, and neoadjuvant therapy. After risk adjustment, PBT is associated with decreased survival, while increasing transfusion requirements are associated with poorer outcome. This is the largest single-institution study confirming the effects of PBT on long-term outcomes after pancreatectomy for PDAC.