The significance of allogenic blood transfusion in the prognosis of patients with esophageal carcinoma remains controversial. We have recently shown that survival in patients with adenocarcinoma (AdenoCa) is significantly lower than in patients with squamous cell carninoma (Sq Cell Ca). The objective of the current study was to elucidate the correlation between peri-operative allogenic blood transfusion and the poorer prognosis in patients with adenocarcinoma.
The study group compromised 509 consecutive patients (312 men and 197 women) with a mean age of 69 years who underwent esophagectomy between 1990 and 2001 in one unit. The clinico-pathological data and survival were compared between 171 patients (63.8%) with AdeonCa and 97 (36.2%) with Sq Cell Ca who received an peri-operative blood transfusion and 178 (73.9%) with AdenoCa and 63 (26.1%) patients who did not.
The operative mortality was 5.5% (28 deaths). Median operative blood loss was 580 mL (range, 125 to 4,500 mL). Mean blood transfusion was 2.4 units (range, 0 to 8 units). Overall actuarial 1-, 5- and 10 year survival rates in the AdenoCa and Sq Cell Ca groups were 52.7%, 14.9% and 8.7% and 55.6%, 35.9%, 21.7% respectively. Multivariate analysis demonstrated that the factors that appeared to independently to determine prognosis in both groups were depth of tumour (p<0.001), lymph node metastasis (p<0.001) and post-operative complications (p=0.029). Peri-operative blood transfusion was not found to be an independent prognostic indicator in either group.CONCLUSIONS & CLINICAL IMPLICATIONS: This study demonstrates that late survival in patients with adenocarcinoma of the esophagus is significantly worse than squamous cell carcinoma but is independent of allogenic peri-operative blood transfusion but re-affirms the importance of tumor invasion and lymph node involvement in the overall poor prognosis of these patients.
S. Ghosh, None.