The impact of perioperative blood transfusion on cancer recurrence and survival following radical cystectomy.

Linder BJ, Frank I, Cheville JC, et al.
Eur Urol 2013;63:839-845.
NATA Rating :
Review by : T. Frietsch
NATA Review

This study by Lindner et al. increases the suspicion that allogeneic blood transfusion for cancer surgery may worsen outcomes. In congruence with a Cochrane analysis of colon cancer surgery, the authors add to the evidence on immunosuppression from blood transfusion, the so-called TRIM (transfusion-induced immunomodulation). Allogeneic blood transfusion induced an increase in bladder cancer recurrence following radical cystectomy, shortened the time until relapse and, overall, increased mortality independently of individual risk factors such as tumor stage or effective tumor resection. The more units of blood were given, the worse the risk of cancer-specific and all-cause mortality (for example, one unit increased mortality by 7%). Two previous studies (which included fewer patients) examined the impact of blood transfusion on the outcome of bladder cancer surgery and found similar but not identical results. In the absence of better prospective data, the conclusion of the authors is absolutely correct: “…continued efforts to limit the use of blood products in these patients are warranted; these efforts include implementing restrictive transfusion criteria or alternative strategies for blood replacement and surgical techniques to minimize blood loss.”

– Thomas Frietsch