Intraoperative blood transfusion contributes to decreased long-term survival of patients with esophageal cancer.

Background: Several prognostic factors for patients who have undergone esophagectomy owing to esophageal squamous cell carcinoma have been suggested, including intraoperative blood loss. There are few data, however, suggesting such an association with the prognosis following radical esophagectomy.

Methods: Patients with esophageal squamous cell carcinoma who underwent radical esophagectomy were divided into two groups based on the median value of the intraoperative blood loss (510 g). A multivariate Cox proportional-hazard regression analysis was performed to determine if intraoperative blood loss could be an independent prognostic factor for long-term survival following radical esophagectomy. Kaplan-Meier survival analysis with a log-rank test was performed between the groups.

Results: From April 2005 to May 2009, a total of 37 patients underwent radical esophagectomy for the treatment of esophageal squamous cell carcinoma at the Juntendo Shizuoka Hospital and were assigned either to one of two groups: those with ≥510 g blood loss [bleeding group (BG), n = 19] or of those with <510 g blood loss [less bleeding group (LBG), n = 18]. The distribution of the stage of disease, the number of positive lymph nodes, and the presence of lymphatic and vascular invasion was comparable between the groups, but the Kaplan-Meier survival analysis demonstrated that survival was significantly worse in the BG group than in the LBG group (p = 0.00295). This was supported by the multivariate analysis, which indicated that intraoperative blood loss was independently associated with long-term survival after radical esophagectomy.

Conclusions: Intraoperative blood loss could be a useful prognostic factor following radical esophagectomy in patients with esophageal squamous cell carcinoma.