Impact of autologous blood transfusion on survival and recurrence for patients undergoing hepatectomy for colorectal cancer liver metastases
*Ravinder Kang1, *Bronte E Seath2, *Viola Huang1, Richard J. Barth Jr.1
1Dartmouth Hitchcock Medical Center, Lebanon, NH;2Geisel School of Medicine at Dartmouth, Hanover, NH
Objective: Autologous transfusion has long been considered unsafe in major oncologic surgery due to a theoretic risk of spreading metastatic disease, however, little data supports this assumption. Our objective was to challenge this assumption by evaluating the risk of recurrence and overall survival in patients receiving autologous transfusions during liver resection for colorectal metastases. Design: Retrospective cohort study. Setting: Academic medical center. Patients: 140 adults undergoing liver resections for colorectal metastases. Interventions: N/A Main Outcome Measure(s): Overall survival (OS) and recurrence-free survival (RFS) at 10 years using Kaplan-Meier survival curves and adjusted Hazard Ratio for OS and RFS. Results:67 patients received an autologous transfusion and 73 received no transfusion. Those receiving a transfusion had greater blood loss, larger surgical resections, and longer procedures. There was no difference in age, sex, proportion colon vs rectal cancer or Fong clinical risk score. Median follow-up was 44 months. The OS was similar among those who received and didn’t receive a transfusion (p=0.85, Figure 1). Even after adjusting for age, sex, Fong score, extent of resection and blood loss, no difference in OS was noted (hazard ratio (autologous vs no-transfusion) 0.60 (95% confidence interval (CI): 0.32-1.12; p = 0.11). RFS was also similar in the two groups(p=0.22). The adjusted hazard ratio for RFS was 1.01 (95% CI: 0.58-1.77; P = 0.96). Conclusions:Autologous blood transfusion is not associated with increased recurrence risk or higher mortality rate. Surgeons performing liver resections for patients with colorectal cancer metastases can safely transfuse filtered autologous blood. 
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