This retrospective study shows that intraoperative blood loss is a prognostic factor after curative resection of esophageal squamous cell carcinoma. After exclusion of 6 patients (including 4 who died within 90 days), 37 patients were divided into 2 groups based on the median value of intraoperative blood loss (510 g). Long-term survival was significantly worse in the bleeding group than in the less-bleeding group. Blood transfusion and intraoperative blood loss were independent prognostic factors (such independence is surprising), however their hazard ratios were lower than the stage of the disease or positive lymph nodes.

This retrospective analysis confirms previously published data: intraoperative blood loss is a pronostic factor in cancer surgery. The authors conclude that every effort should be made to reduce intraoperative blood loss. Interestingly, the authors discuss the potential role of systemic inflammation and impaired immunity to explain their results.

– Anne Godier

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