Effect of blood transfusion on outcome after pancreaticoduodenectomy for exocrine tumour of the pancreas

Background: Blood transfusion is thought to have an immunosuppressiv effect. The aims of this study were to examine survival in patients with pancreatic cancer receiving blood transfusion in association with pancreaticoduodenectomy, and to define preoperative risk factors for subsequent transfusion. Methods: A retrospective review was performed of a prospective database of patients with exocrine tumours of the head of the pancreas who had undergone pancreaticoduodenectomy between 1998 and 2003. Clinical data, transfusion records and preoperative laboratory values were recorded. Results: A total of 294 patients underwent pancreaticoduodenectomy for exocrine tumours in the pancreatic head. Of these, 140 (47.6 per cent) received a blood transfusion. Their median survival was 18 months, compared with 24 months for those who did not have a transfusion (P = 0.036). Postoperative transfusion, margin status and node stage were independent predictors of survival. Age and preoperative total bilirubin and haemoglobin levels were the only preoperative factors that correlated with transfusion. Conclusion: In patients with exocrine tumours; of the pancreas, blood transfusion should be avoided when possible. Preoperative risk factors can identify patients who are likely to require transfusion and would therefore benefit most from blood conservation methods.