Current Anesthesiology Reports

, Volume 8, Issue 4, pp 426–438 | Cite as

Transfusion Therapy: Is There a Link with Cancer Recurrence?

  • Ruben D. Agudelo-Jimenez
  • Juliana A. Heatter
  • Juan P. CataEmail author
Cancer Anesthesia (B Riedel and V Gottumukkala, Section Editors)
Part of the following topical collections:
  1. Cancer Anesthesia


Purpose of Review

To present an updated narrative review of the available clinical evidence regarding the impact of perioperative anemia and blood product administration on cancer recurrence and mortality. To address some of the current strategies to reduce blood transfusions and their safety in oncologic surgery.

Recent Findings

Both anemia and packed red blood cells (pRBCs) transfusions have been associated with an increased risk of recurrence and mortality in certain solid malignancies. Anemia directly stimulates protective mechanisms against apoptosis of cancer cells while promoting a favorable micro-environment and reducing the efficacy of anticancer therapies. When transfusion occurs, transfusion-related immunomodulation (TRIM) mediates the immunosuppression and inflammation responsible for the impairment of the host immune system to appropriately eliminate cancer cells. However, pRBCs can also promote tumor growth by non-TRIM mechanisms.


Evidence of the negative impact of perioperative anemia and blood transfusions on cancer recurrence and mortality should raise concern about the appropriate timing of blood transfusions in patients with cancer undergoing surgical procedures. Blood sparing strategies such as acute normovolemic hemodilution, autologous pRBCs transfusions and intraoperative cell savage appear to be safe means to minimize allogeneic pRBCs in the context of cancer surgery, although the safety of these strategies has not been rigorously tested in randomized controlled trials.


Anemia Blood transfusion Cancer Recurrence Survival 


Compliance with Ethical Standards

Conflict of Interest

Ruben D. Agudelo-Jimenez, Juliana A. Heatter, and Juan P. Cata declare they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Dunn A, Carter J, Carter H. Anemia at the end of life: prevalence, significance, and causes in patients receiving palliative care. J Pain Symptom Manag. 2003;26(6):1132–9.CrossRefGoogle Scholar
  2. 2.
    Ludwig H, Van Belle S, Barrett-Lee P, Birgegard G, Bokemeyer C, Gascon P, et al. The European Cancer Anaemia Survey (ECAS): a large, multinational, prospective survey defining the prevalence, incidence, and treatment of anaemia in cancer patients. Eur J Cancer (Oxford, England : 1990). 2004;40(15):2293–306. Scholar
  3. 3.
    Rodgers GM 3rd, Becker PS, Blinder M, Cella D, Chanan-Khan A, Cleeland C, et al. Cancer- and chemotherapy-induced anemia. J Natl Compr Canc Netw : JNCCN. 2012;10(5):628–53.CrossRefGoogle Scholar
  4. 4.
    Xu H, Xu L, Page JH, Cannavale K, Sattayapiwat O, Rodriguez R, et al. Incidence of anemia in patients diagnosed with solid tumors receiving chemotherapy, 2010-2013. Clin Epidemiol. 2016;8:61–71. Scholar
  5. 5.
    Neoh K, Stanworth S, Pasricha SR, Bennett MI. Estimating prevalence of functional iron deficiency anaemia in advanced cancer. Support Care Cancer. 2017;25(4):1209–14. Scholar
  6. 6.
    Spivak JL. The anaemia of cancer: death by a thousand cuts. Nat Rev Cancer. 2005;5(7):543–55. Scholar
  7. 7.
    • Sapiano MRP, Savinkina AA, Ellingson KD, Haass KA, Baker ML, Henry RA, et al. Supplemental findings from the National Blood Collection and Utilization Surveys, 2013 and 2015. Transfusion. 2017;57(Suppl 2):1599–624. Results from the latest National Blood Collection & Utilization Survey (NBCUS). It is the largest official source of the number of blood and blood components collected and transfused in the United States. CrossRefPubMedGoogle Scholar
  8. 8.
    Vamvakas EC, Blajchman MA. Transfusion-related immunomodulation (TRIM): an update. Blood Rev. 2007;21(6):327–48. Scholar
  9. 9.
    Ejaz A, Spolverato G, Kim Y, Poultsides GA, Fields RC, Bloomston M, et al. Impact of body mass index on perioperative outcomes and survival after resection for gastric cancer. J Surg Res. 2015;195(1):74–82. Scholar
  10. 10.
    Caro JJ, Salas M, Ward A, Goss G. Anemia as an independent prognostic factor for survival in patients with cancer: a systemic, quantitative review. Cancer. 2001;91(12):2214–21.CrossRefGoogle Scholar
  11. 11.
    Wigmore TJ, Mohammed K, Jhanji S. Long-term survival for patients undergoing volatile versus IV anesthesia for cancer surgery: a retrospective analysis. Anesthesiology. 2016;124(1):69–79. Scholar
  12. 12.
    Cata JP, Gottumukkala V, Sessler DI. How regional analgesia might reduce postoperative cancer recurrence. Eur J Pain Suppl. 2011;5(S2):345-55. Suppl. 2011;5(S2):345–355.
  13. 13.
    Melamed R, Rosenne E, Shakhar K, Schwartz Y, Abudarham N, Ben-Eliyahu S. Marginating pulmonary-NK activity and resistance to experimental tumor metastasis: suppression by surgery and the prophylactic use of a beta-adrenergic antagonist and a prostaglandin synthesis inhibitor. Brain Behav Immun. 2005;19(2):114–26. Scholar
  14. 14.
    Alazawi W, Pirmadjid N, Lahiri R, Bhattacharya S. Inflammatory and immune responses to surgery and their clinical impact. Ann Surg. 2016;264(1):73–80. Scholar
  15. 15.
    Amato A, Pescatori M. Perioperative blood transfusions for the recurrence of colorectal cancer. Cochrane Database Syst Rev. 2006;(1):Cd005033.
  16. 16.
    Woolley AL, Hogikyan ND, Gates GA, Haughey BH, Schechtman KB, Goldenberg JL. Effect of blood transfusion on recurrence of head and neck carcinoma. Retrospective review and meta-analysis. Ann Otol Rhinol Laryngol. 1992;101(9):724–30. Scholar
  17. 17.
    Boehm K, Beyer B, Tennstedt P, Schiffmann J, Budaeus L, Haese A, et al. No impact of blood transfusion on oncological outcome after radical prostatectomy in patients with prostate cancer. World J Urol. 2015;33(6):801–6. Scholar
  18. 18.
    Monk BJ, Tewari K, Gamboa-Vujicic G, Burger RA, Manetta A, Berman ML. Does perioperative blood transfusion affect survival in patients with cervical cancer treated with radical hysterectomy? Obstet Gynecol. 1995;85(3):343–8. Scholar
  19. 19.
    Maccio A, Madeddu C, Massa D, Mudu MC, Lusso MR, Gramignano G, et al. Hemoglobin levels correlate with interleukin-6 levels in patients with advanced untreated epithelial ovarian cancer: role of inflammation in cancer-related anemia. Blood. 2005;106(1):362–7. Scholar
  20. 20.
    Wang GL, Jiang BH, Rue EA, Semenza GL. Hypoxia-inducible factor 1 is a basic-helix-loop-helix-PAS heterodimer regulated by cellular O2 tension. Proc Natl Acad Sci U S A. 1995;92(12):5510–4.CrossRefGoogle Scholar
  21. 21.
    Semenza GL. HIF-1: upstream and downstream of cancer metabolism. Curr Opin Genet Dev. 2010;20(1):51–6. Scholar
  22. 22.
    Vaupel P, Kelleher DK, Hockel M. Oxygen status of malignant tumors: pathogenesis of hypoxia and significance for tumor therapy. Semin Oncol. 2001;28(2 Suppl 8):29–35.CrossRefGoogle Scholar
  23. 23.
    Mayr NA, Wang JZ, Zhang D, Montebello JF, Grecula JC, Lo SS, et al. Synergistic effects of hemoglobin and tumor perfusion on tumor control and survival in cervical cancer. Int J Radiat Oncol Biol Phys. 2009;74(5):1513–21. Scholar
  24. 24.
    Rockwell S, Dobrucki IT, Kim EY, Marrison ST, Vu VT. Hypoxia and radiation therapy: past history, ongoing research, and future promise. Curr Mol Med. 2009;9(4):442–58.CrossRefGoogle Scholar
  25. 25.
    • Karakashev SV, Reginato MJ. Progress toward overcoming hypoxia-induced resistance to solid tumor therapy. Cancer Manag Res. 2015;7:253–64. This manuscript reviews the different mechanisms of hypoxia-mediated resistance to cancer therapy. CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Ding Z, Yang L, Xie X, Xie F, Pan F, Li J, et al. Expression and significance of hypoxia-inducible factor-1 alpha and MDR1/P-glycoprotein in human colon carcinoma tissue and cells. J Cancer Res Clin Oncol. 2010;136(11):1697–707. Scholar
  27. 27.
    Liu L, Ning X, Sun L, Zhang H, Shi Y, Guo C, et al. Hypoxia-inducible factor-1 alpha contributes to hypoxia-induced chemoresistance in gastric cancer. Cancer Sci. 2008;99(1):121–8. Scholar
  28. 28.
    Grivennikov SI, Greten FR, Karin M. Immunity, inflammation, and cancer. Cell. 2010;140(6):883–99. Scholar
  29. 29.
    Balamurugan K. HIF-1 at the crossroads of hypoxia, inflammation, and cancer. Int J Cancer. 2016;138(5):1058–66. Scholar
  30. 30.
    Knight K, Wade S, Balducci L. Prevalence and outcomes of anemia in cancer: a systematic review of the literature. Am J Med. 2004;116(Suppl 7A):11s–26s. Scholar
  31. 31.
    van de Pol SM, Doornaert PA, de Bree R, Leemans CR, Slotman BJ, Langendijk JA. The significance of anemia in squamous cell head and neck cancer treated with surgery and postoperative radiotherapy. Oral Oncol. 2006;42(2):131–8. Scholar
  32. 32.
    Dietl B, Marienhagen J, Schafer C, Kolbl O. The prognostic value of anaemia at different treatment times in patients with locally advanced head and neck cancer treated with surgery and postoperative radiotherapy. Clin Oncol (R Coll Radiol). 2007;19(4):228–33. Scholar
  33. 33.
    Reichel O, Panzer M, Wimmer C, Duhmke E, Kastenbauer E, Suckfull M. Prognostic implications of hemoglobin levels before and after surgery as well as before and after radiochemotherapy for head and neck tumors. Eur Arch Otorhinolaryngol : Official Journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery. 2003;260(5):248–53. Scholar
  34. 34.
    Cordella C, Luebbers HT, Rivelli V, Gratz KW, Kruse AL. An evaluation of the preoperative hemoglobin level as a prognostic factor for oral squamous cell carcinoma. Head Neck Oncol. 2011;3:35. Scholar
  35. 35.
    Yovino S, Kwok Y, Krasna M, Bangalore M, Suntharalingam M. An association between preoperative anemia and decreased survival in early-stage non-small-cell lung cancer patients treated with surgery alone. Int J Radiat Oncol Biol Phys. 2005;62(5):1438–43. Scholar
  36. 36.
    Chamogeorgakis T, Anagnostopoulos C, Kostopanagiotou G, Bhora F, Toumpoulis I, Georgiannakis E, et al. Does anemia affect outcome after lobectomy or pneumonectomy in early stage lung cancer patients who have not received neo-adjuvant treatment? Thorac Cardiovasc Surg. 2008;56(3):148–53. Scholar
  37. 37.
    Shen JG, Cheong JH, Hyung WJ, Kim J, Choi SH, Noh SH. Pretreatment anemia is associated with poorer survival in patients with stage I and II gastric cancer. J Surg Oncol. 2005;91(2):126–30. Scholar
  38. 38.
    Liu X, Qiu H, Huang Y, Xu D, Li W, Li Y, et al. Impact of preoperative anemia on outcomes in patients undergoing curative resection for gastric cancer: a single-institution retrospective analysis of 2163 Chinese patients. Cancer Med. 2018;7(2):360–9. Scholar
  39. 39.
    • Wilson MJ, van Haaren M, Harlaar JJ, Park HC, Bonjer HJ, Jeekel J, et al. Long-term prognostic value of preoperative anemia in patients with colorectal cancer: a systematic review and meta-analysis. Surg Oncol. 2017;26(1):96–104. This is the largest meta-analysis linking preoperative anemia and worse outcomes in patients with colorectal cancer. CrossRefPubMedGoogle Scholar
  40. 40.
    Ruiz-Tovar J, Martin-Perez E, Fernandez-Contreras ME, Reguero-Callejas ME, Gamallo-Amat C. Impact of preoperative levels of hemoglobin and albumin on the survival of pancreatic carcinoma. Rev Esp Enferm Dig : organo oficial de la Sociedad Espanola de Patologia Digestiva. 2010;102(11):631–6.CrossRefGoogle Scholar
  41. 41.
    Nakamura T, Grimer R, Gaston C, Carter S, Tillman R, Abudu A, et al. The relationship between pretreatment anaemia and survival in patients with adult soft tissue sarcoma. J Orthop Sci : Official Journal of the Japanese Orthopaedic Association. 2013;18(6):987–93. Scholar
  42. 42.
    Szkandera J, Gerger A, Liegl-Atzwanger B, Stotz M, Samonigg H, Ploner F, et al. Pre-treatment anemia is a poor prognostic factor in soft tissue sarcoma patients. PLoS One. 2014;9(9):e107297. Scholar
  43. 43.
    Xia L, Hu G, Guzzo TJ. Prognostic significance of preoperative anemia in patients undergoing surgery for renal cell carcinoma: a meta-analysis. Anticancer Res. 2017;37(6):3175–81. Scholar
  44. 44.
    Xia L, Guzzo TJ. Preoperative anemia and low hemoglobin level are associated with worse clinical outcomes in patients with bladder cancer undergoing radical cystectomy: a meta-analysis. Clin Genitourin Cancer. 2017;15(2):263–72.e4. Scholar
  45. 45.
    Luo F, Wang YS, Su YH, Zhang ZH, Sun HH, Li J. Prognostic implications of preoperative anemia in urothelial carcinoma: a meta-analysis. PLoS One. 2017;12(2):e0171701. Scholar
  46. 46.
    Kandemir EG, Mayadagli A, Turken O, Yaylaci M, Ozturk A. Pre-treatment haemoglobin concentration is a prognostic factor in patients with early-stage breast cancer. J Int Med Res. 2005;33(3):319–28. Scholar
  47. 47.
    Henke M, Sindlinger F, Ikenberg H, Gerds T, Schumacher M. Blood hemoglobin level and treatment outcome of early breast cancer. Strahlenther Onkol : Organ der Deutschen Rontgengesellschaft [et al]. 2004;180(1):45–51. Scholar
  48. 48.
    Obermair A, Petru E, Windbichler G, Peters-Engl C, Graf AH, Stummvoll W, et al. Significance of pretreatment serum hemoglobin and survival in epithelial ovarian cancer. Oncol Rep. 2000;7(3):639–44.PubMedGoogle Scholar
  49. 49.
    Obermair A, Handisurya A, Kaider A, Sevelda P, Kolbl H, Gitsch G. The relationship of pretreatment serum hemoglobin level to the survival of epithelial ovarian carcinoma patients: a prospective review. Cancer. 1998;83(4):726–31.CrossRefGoogle Scholar
  50. 50.
    Lim S, Lee CM, Park JM, Jung SY, Lee KB. An association between preoperative anemia and poor prognostic factors and decreased survival in early stage cervical cancer patients. Obstet Gynecol Sci. 2014;57(6):471–7. Scholar
  51. 51.
    Gadducci A, Cosio S, Zola P, Tisi G, Ferrero A, Piovano E, et al. Pretreatment platelet and hemoglobin levels are neither predictive nor prognostic variables for patients with locally advanced cervical cancer treated with neoadjuvant chemotherapy and radical hysterectomy: a retrospective Italian study. Int J Gynecol Cancer : official journal of the International Gynecological Cancer Society. 2010;20(8):1399–404. Scholar
  52. 52.
    Ferrandina G, Distefano M, Smaniotto D, Morganti A, Paglia A, Macchia G, et al. Anemia in patients with locally advanced cervical carcinoma administered preoperative radiochemotherapy: association with pathological response to treatment and clinical outcome. Gynecol Oncol. 2006;103(2):500–5. Scholar
  53. 53.
    Martin-Loeches M, Orti RM, Asins E, Llixiona J. The prognostic implications of anaemia in the outcome of patients with early stages of uterine cervix carcinoma. Arch Gynecol Obstet. 2003;267(3):121–5. Scholar
  54. 54.
    Shin NR, Lee YY, Kim SH, Choi CH, Kim TJ, Lee JW, et al. Prognostic value of pretreatment hemoglobin level in patients with early cervical cancer. Obstet Gynecol Sci. 2014;57(1):28–36. Scholar
  55. 55.
    Wilairat W, Benjapibal M. Presence of anemia and poor prognostic factors in patients with endometrial carcinoma. Asian Pac J Cancer Prev : APJCP. 2012;13(7):3187–90.CrossRefGoogle Scholar
  56. 56.
    Metindir J, Bilir DG. Preoperative hemoglobin and platelet count and poor prognostic factors in patients with endometrial carcinoma. J Cancer Res Clin Oncol. 2009;135(1):125–9. Scholar
  57. 57.
    Tamussino KF, Gucer F, Reich O, Moser F, Petru E, Scholz HS. Pretreatment hemoglobin, platelet count, and prognosis in endometrial carcinoma. Int J Gynecol Cancer : Official Journal of the International Gynecological Cancer Society. 2001;11(3):236–40.CrossRefGoogle Scholar
  58. 58.
    Njolstad TS, Engerud H, Werner HM, Salvesen HB, Trovik J. Preoperative anemia, leukocytosis and thrombocytosis identify aggressive endometrial carcinomas. Gynecol Oncol. 2013;131(2):410–5. Scholar
  59. 59.
    Hallet J, Hanif A, Callum J, Pronina I, Wallace D, Yohanathan L, et al. The impact of perioperative iron on the use of red blood cell transfusions in gastrointestinal surgery: a systematic review and meta-analysis. Transfus Med Rev. 2014;28(4):205–11. Scholar
  60. 60.
    Zhao F, Wang Y, Liu L, Bian M. Erythropoietin for cancer-associated malignant anemia: a meta-analysis. Mol Clin Oncol. 2017;6(6):925–30. Scholar
  61. 61.
    Berardi R, Brunelli A, Tamburrano T, Verdecchia L, Onofri A, Zuccatosta L, et al. Perioperative anemia and blood transfusions as prognostic factors in patients undergoing resection for non-small cell lung cancers. Lung Cancer (Amsterdam, Netherlands). 2005;49(3):371–6. Scholar
  62. 62.
    Goubran HA, Elemary M, Radosevich M, Seghatchian J, El-Ekiaby M, Burnouf T. Impact of transfusion on cancer growth and outcome. Cancer Growth Metastasis. 2016;9:1–8. Scholar
  63. 63.
    •• Goubran H, Sheridan D, Radosevic J, Burnouf T, Seghatchian J. Transfusion-related immunomodulation and cancer. Transfus Apher Sci : Official Journal of the World Apheresis Association : Official Journal of the European Society for Haemapheresis. 2017;56(3):336–40. This is an updated review of transfusion-related immunomodulation and its significance for recurrence in the cancer surgical patient. CrossRefGoogle Scholar
  64. 64.
    Antonelou MH, Seghatchian J. Insights into red blood cell storage lesion: toward a new appreciation. Transfus Apher Sci : Official Journal of the World Apheresis Association : Official Journal of the European Society for Haemapheresis. 2016;55(3):292–301. Scholar
  65. 65.
    Baumgartner JM, Silliman CC, Moore EE, Banerjee A, McCarter MD. Stored red blood cell transfusion induces regulatory T cells. J Am Coll Surg. 2009;208(1):110–9. Scholar
  66. 66.
    Wood ML, Gottschalk R, Monaco AP. Effect of blood transfusion on IL-2 production. Transplantation. 1988;45(5):930–5.CrossRefGoogle Scholar
  67. 67.
    Kaplan J, Sarnaik S, Gitlin J, Lusher J. Diminished helper/suppressor lymphocyte ratios and natural killer activity in recipients of repeated blood transfusions. Blood. 1984;64(1):308–10.PubMedGoogle Scholar
  68. 68.
    Baumgartner JM, Nydam TL, Clarke JH, Banerjee A, Silliman CC, McCarter MD. Red blood cell supernatant potentiates LPS-induced proinflammatory cytokine response from peripheral blood mononuclear cells. J Interferon Cytokine Res : the official journal of the International Society for Interferon and Cytokine Research. 2009;29(6):333–8. Scholar
  69. 69.
    Mynster T. Effects of red cell storage and lysis on in vitro cytokine release. Transfus Apher Sci : Official Journal of the World Apheresis Association : official journal of the European Society for Haemapheresis. 2001;25(1):17–23.Google Scholar
  70. 70.
    Cata JP, Wang H, Gottumukkala V, Reuben J, Sessler DI. Inflammatory response, immunosuppression, and cancer recurrence after perioperative blood transfusions. Br J Anaesth. 2013;110(5):690–701. Scholar
  71. 71.
    Seghatchian J. Universal leucodepletion: an overview of some unresolved issues and the highlights of lessons learned. Transfusion and Apheresis Science : Official Journal of the World Apheresis Association : official journal of the European Society for Haemapheresis. 2003;29(2):105–17.
  72. 72.
    Vallion R, Bonnefoy F, Daoui A, Vieille L, Tiberghien P, Saas P, et al. Transforming growth factor-beta released by apoptotic white blood cells during red blood cell storage promotes transfusion-induced alloimmunomodulation. Transfusion. 2015;55(7):1721–35. Scholar
  73. 73.
    Nielsen HJ, Werther K, Mynster T, Brunner N. Soluble vascular endothelial growth factor in various blood transfusion components. Transfusion. 1999;39(10):1078–83.CrossRefGoogle Scholar
  74. 74.
    Benson DD, Beck AW, Burdine MS, Brekken R, Silliman CC, Barnett CC Jr. Accumulation of pro-cancer cytokines in the plasma fraction of stored packed red cells. J Gastrointest Surg : Official Journal of the Society for Surgery of the Alimentary Tract. 2012;16(3):460–8. Scholar
  75. 75.
    Offner PJ, Moore EE, Biffl WL, Johnson JL, Silliman CC. Increased rate of infection associated with transfusion of old blood after severe injury. Archives of Surgery (Chicago, Ill : 1960). 2002;137(6):711–6 discussion 6-7.CrossRefGoogle Scholar
  76. 76.
    Azenshtein E, Luboshits G, Shina S, Neumark E, Shahbazian D, Weil M, et al. The CC chemokine RANTES in breast carcinoma progression: regulation of expression and potential mechanisms of promalignant activity. Cancer Res. 2002;62(4):1093–102.PubMedGoogle Scholar
  77. 77.
    Niwa Y, Akamatsu H, Niwa H, Sumi H, Ozaki Y, Abe A. Correlation of tissue and plasma RANTES levels with disease course in patients with breast or cervical cancer. Clin Cancer Res : an Official Journal of the American Association for Cancer Research. 2001;7(2):285–9.Google Scholar
  78. 78.
    Shimoyama S, Gansauge F, Gansauge S, Negri G, Oohara T, Beger HG. Increased angiogenin expression in pancreatic cancer is related to cancer aggressiveness. Cancer Res. 1996;56(12):2703–6.PubMedGoogle Scholar
  79. 79.
    Luan H, Ye F, Wu L, Zhou Y, Jiang J. Perioperative blood transfusion adversely affects prognosis after resection of lung cancer: a systematic review and a meta-analysis. BMC Surg. 2014;14:34. Scholar
  80. 80.
    Rinker BD, Bowling JT, Vasconez HC. Blood transfusion and risk of metastatic disease or recurrence in patients undergoing immediate TRAM flap breast reconstruction: a clinical study and meta-analysis. Plast Reconstr Surg. 2007;119(7):2001–7.
  81. 81.
    Soubra A, Zabell JR, Adejoro O, Konety BR. Effect of perioperative blood transfusion on mortality for major urologic malignancies. Clin Genitourin Cancer. 2015;13(3):e173–81. Scholar
  82. 82.
    • Li SL, Ye Y, Yuan XH. Association between allogeneic or autologous blood transfusion and survival in patients after radical prostatectomy: a systematic review and meta-analysis. PloS One. 2017;12(1):e0171081. This meta-analysis evaluates the impact of perioperative transfusions and malignancy progression in patients with prostate cancer undergoing radical prostatectomy. CrossRefPubMedPubMedCentralGoogle Scholar
  83. 83.
    Acheson AG, Brookes MJ, Spahn DR. Effects of allogeneic red blood cell transfusions on clinical outcomes in patients undergoing colorectal cancer surgery: a systematic review and meta-analysis. Ann Surg. 2012;256(2):235–44. Scholar
  84. 84.
    •• American Society of Anesthesiologists Task Force on Perioperative Blood M. Practice guidelines for perioperative blood management: an updated report by the American Society of Anesthesiologists Task Force on Perioperative Blood Management*. Anesthesiology. 2015;122(2):241–75. Guidelines with the most updated consensus of the American Society of Anesthesiologists about perioperative blood management. CrossRefGoogle Scholar
  85. 85.
    •• de Almeida JP, Vincent JL, Galas FR, de Almeida EP, Fukushima JT, Osawa EA, et al. Transfusion requirements in surgical oncology patients: a prospective, randomized controlled trial. Anesthesiology. 2015;122(1):29–38. This is a randomized, controlled, parallel-group, double-blind trial study that evaluated efficacy of restrictive vs. liberal blood transfusions in surgical oncology patients at the intensive care unit. CrossRefPubMedGoogle Scholar
  86. 86.
    Amato AC, Pescatori M. Effect of perioperative blood transfusions on recurrence of colorectal cancer: meta-analysis stratified on risk factors. Dis Colon Rectum. 1998;41(5):570–85.CrossRefGoogle Scholar
  87. 87.
    • Lyu X, Qiao W, Li D, Leng Y. Impact of perioperative blood transfusion on clinical outcomes in patients with colorectal liver metastasis after hepatectomy: a meta-analysis. Oncotarget. 2017;8(25):41740–8. This meta-analysis investigated the association between perioperative blood transfusion and worse outcomes in colorectal cancer. CrossRefPubMedPubMedCentralGoogle Scholar
  88. 88.
    Saxena A, Valle SJ, Liauw W, Morris DL. Allogenic blood transfusion is an independent predictor of poorer peri-operative outcomes and reduced long-term survival after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: a review of 936 cases. J Gastrointest Surg : Official Journal of the Society for Surgery of the Alimentary Tract. 2017;21(8):1318–27. Scholar
  89. 89.
    Aquina CT, Blumberg N, Becerra AZ, Boscoe FP, Schymura MJ, Noyes K, et al. Association among blood transfusion, sepsis, and decreased long-term survival after colon cancer resection. Ann Surg. 2017;266(2):311–7. Scholar
  90. 90.
    Patel SV, Brennan KE, Nanji S, Karim S, Merchant S, Booth CM. Peri-operative blood transfusion for resected colon cancer: practice patterns and outcomes in a population-based study. Cancer Epidemiol. 2017;51:35–40. Scholar
  91. 91.
    Li L, Zhu D, Chen X, Huang Y, Ouyang M, Zhang W. Perioperative Allogenenic blood transfusion is associated with worse clinical outcome for patients undergoing gastric carcinoma surgery: a meta-analysis. Medicine. 2015;94(39):e1574. Scholar
  92. 92.
    Agnes A, Lirosi MC, Panunzi S, Santocchi P, Persiani R, D'Ugo D. The prognostic role of perioperative allogeneic blood transfusions in gastric cancer patients undergoing curative resection: a systematic review and meta-analysis of non-randomized, adjusted studies. Eur J Surg Oncol : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology. 2018;44(4):404–19. Scholar
  93. 93.
    Boshier PR, Ziff C, Adam ME, Fehervari M, Markar SR, Hanna GB. Effect of perioperative blood transfusion on the long-term survival of patients undergoing esophagectomy for esophageal cancer: a systematic review and meta-analysis. Dis Esophagus : Official Journal of the International Society for Diseases of the Esophagus. 2018;31(4).
  94. 94.
    Reeh M, Ghadban T, Dedow J, Vettorazzi E, Uzunoglu F, Nentwich M, et al. Allogenic blood transfusion is associated with poor perioperative and long-term outcome in esophageal cancer. World J Surg. 2017;41(1):208–15. Scholar
  95. 95.
    Lee J, Chin JH, Kim JI, Lee EH, Choi IC. Association between red blood cell transfusion and long-term mortality in patients with cancer of the esophagus after esophagectomy. Dis Esophagus : Official Journal of the International Society for Diseases of the Esophagus. 2018;31(2).
  96. 96.
    Wang Q, Du T, Lu C. Perioperative blood transfusion and the clinical outcomes of patients undergoing cholangiocarcinoma surgery: a systematic review and meta-analysis. Eur J Gastroenterol Hepatol. 2016;28(11):1233–40. Scholar
  97. 97.
    Zhou PY, Tang Z, Liu WR, Tian MX, Jin L, Jiang XF, et al. Perioperative blood transfusion does not affect recurrence-free and overall survivals after curative resection for intrahepatic cholangiocarcinoma: a propensity score matching analysis. BMC Cancer. 2017;17(1):762. Scholar
  98. 98.
    Gomez-Gavara C, Doussot A, Lim C, Salloum C, Lahat E, Fuks D, et al. Impact of intraoperative blood transfusion on short and long term outcomes after curative hepatectomy for intrahepatic cholangiocarcinoma: a propensity score matching analysis by the AFC-IHCC study group. HPB (Oxford) : the Official Journal of the International Hepato Pancreato Biliary Association. 2017;19(5):411–20. Scholar
  99. 99.
    Dai WC, Chok KSH, Sin SL, Chan ACY, Cheung TT, Wong TCL, et al. Impact of intraoperative blood transfusion on long-term outcomes of liver transplantation for hepatocellular carcinoma. ANZ J Surg. 2018;88(5):E418–E23. Scholar
  100. 100.
    Wada H, Eguchi H, Nagano H, Kubo S, Nakai T, Kaibori M, et al. Perioperative allogenic blood transfusion is a poor prognostic factor after hepatocellular carcinoma surgery: a multi-center analysis. Surg Today. 2018;48(1):73–9. Scholar
  101. 101.
    Liu L, Wang Z, Jiang S, Shao B, Liu J, Zhang S, et al. Perioperative allogenenic blood transfusion is associated with worse clinical outcomes for hepatocellular carcinoma: a meta-analysis. PLoS One. 2013;8(5):e64261. Scholar
  102. 102.
    Mavros MN, Xu L, Maqsood H, Gani F, Ejaz A, Spolverato G, et al. Perioperative blood transfusion and the prognosis of pancreatic cancer surgery: systematic review and meta-analysis. Ann Surg Oncol. 2015;22(13):4382–91. Scholar
  103. 103.
    Abe T, Amano H, Hanada K, Minami T, Yonehara S, Hattori M, et al. Perioperative red blood cell transfusion is associated with poor long-term survival in pancreatic adenocarcinoma. Anticancer Res. 2017;37(10):5863–70. Scholar
  104. 104.
    Hwang HK, Jung MJ, Lee SH, Kang CM, Lee WJ. Adverse oncologic effects of intraoperative transfusion during pancreatectomy for left-sided pancreatic cancer: the need for strict transfusion policy. J Hepatobiliary Pancreat Sci. 2016;23(8):497–507. Scholar
  105. 105.
    Chau JK, Harris JR, Seikaly HR. Transfusion as a predictor of recurrence and survival in head and neck cancer surgery patients. Journal of Otolaryngology - Head & Neck Surgery = Le Journal d'oto-rhino-laryngologie et de chirurgie cervico-faciale. 2010;39(5):516–22.Google Scholar
  106. 106.
    • Wang YL, Jiang B, Yin FF, Shi HQ, Xu XD, Zheng SS, et al. Perioperative blood transfusion promotes worse outcomes of bladder cancer after radical cystectomy: a systematic review and meta-analysis. PloS One. 2015;10(6):e0130122. This meta-analysis indicated that perioperative blood transfusions were an independent predictor of poor outcomes in cholangiocarcinoma. CrossRefPubMedPubMedCentralGoogle Scholar
  107. 107.
    Cata JP, Lasala J, Pratt G, Feng L, Shah JB. Association between perioperative blood transfusions and clinical outcomes in patients undergoing bladder cancer surgery: a systematic review and meta-analysis study. J Blood Transfus. 2016;2016:9876394. Scholar
  108. 108.
    Chalfin HJ, Liu JJ, Gandhi N, Feng Z, Johnson D, Netto GJ, et al. Blood transfusion is associated with increased perioperative morbidity and adverse oncologic outcomes in bladder cancer patients receiving neoadjuvant chemotherapy and radical cystectomy. Ann Surg Oncol. 2016;23(8):2715–22. Scholar
  109. 109.
    Moschini M, Bianchi M, Gandaglia G, Cucchiara V, Luzzago S, Pellucchi F, et al. The impact of perioperative blood transfusion on survival of bladder cancer patients submitted to radical cystectomy: role of anemia status. J Blood Transfus. 2016;2(1):86–91. Scholar
  110. 110.
    Siemens DR, Jaeger MT, Wei X, Vera-Badillo F, Booth CM. Peri-operative allogeneic blood transfusion and outcomes after radical cystectomy: a population-based study. World J Urol. 2017;35(9):1435–42. Scholar
  111. 111.
    Moschini M, Soria F, Abufaraj M, Foerster B, D'Andrea D, Damiano R, et al. Impact of intra- and postoperative blood transfusion on the incidence, timing, and pattern of disease recurrence after radical cystectomy. Clin Genitourin Cancer. 2017;15(4):e681–e8. Scholar
  112. 112.
    Buchner A, Grimm T, Schneevoigt BS, Wittmann G, Kretschmer A, Jokisch F, et al. Dramatic impact of blood transfusion on cancer-specific survival after radical cystectomy irrespective of tumor stage. Scand J Urol. 2017;51(2):130–6. Scholar
  113. 113.
    Vetterlein MW, Gild P, Kluth LA, Seisen T, Gierth M, Fritsche HM, et al. Peri-operative allogeneic blood transfusion does not adversely affect oncological outcomes after radical cystectomy for urinary bladder cancer: a propensity score-weighted European multicentre study. BJU Int. 2018;121(1):101–10. Scholar
  114. 114.
    Linder BJ, Thompson RH, Leibovich BC, Cheville JC, Lohse CM, Gastineau DA, et al. The impact of perioperative blood transfusion on survival after nephrectomy for non-metastatic renal cell carcinoma (RCC). BJU Int. 2014;114(3):368–74. Scholar
  115. 115.
    Park YH, Kim YJ, Kang SH, Kim HH, Byun SS, Lee JY, et al. Association between perioperative blood transfusion and oncologic outcomes after curative surgery for renal cell carcinoma. J Cancer. 2016;7(8):965–72. Scholar
  116. 116.
    Soria F, de Martino M, Leitner CV, Moschini M, Shariat SF, Klatte T. Perioperative allogenic blood transfusion in renal cell carcinoma: risk factors and effect on long-term outcomes. Clin Genitourin Cancer. 2017;15(3):e421–e7. Scholar
  117. 117.
    Tsivian M, Abern MR, Tsivian E, Sze C, Jibara G, Rampersaud EN Jr, et al. Effect of blood transfusions on oncological outcomes of surgically treated localized renal cell csarcinoma. Urol Oncol. 2018.
  118. 118.
    Abu-Ghanem Y, Zilberman DE, Dotan Z, Kaver I, Ramon J. Perioperative blood transfusion adversely affects prognosis after nephrectomy for renal cell carcinoma. Urol Oncol. 2018;36(1):12.e5–e20. Scholar
  119. 119.
    Poorman CE, Postlewait LM, Ethun CG, Tran TB, Prescott JD, Pawlik TM, et al. Blood transfusion and survival for resected adrenocortical carcinoma: a study from the United States adrenocortical carcinoma group. Am Surg. 2017;83(7):761–8.PubMedPubMedCentralGoogle Scholar
  120. 120.
    Spirtos NM, Westby CM, Averette HE, Soper JT. Blood transfusion and the risk of recurrence in squamous cell carcinoma of the cervix: a gynecologic oncology group study. Am J Clin Oncol. 2002;25(4):398–403.CrossRefGoogle Scholar
  121. 121.
    Bogani G, Ditto A, Martinelli F, Signorelli M, Chiappa V, Lopez C, et al. Impact of blood transfusions on survival of locally advanced cervical cancer patients undergoing neoadjuvant chemotherapy plus radical surgery. Int J Gynecol Cancer : Official Journal of the International Gynecological Cancer Society. 2017;27(3):514–22. Scholar
  122. 122.
    De Oliveira GS Jr, Schink JC, Buoy C, Ahmad S, Fitzgerald PC, RJ MC. The association between allogeneic perioperative blood transfusion on tumour recurrence and survival in patients with advanced ovarian cancer. Transfus Med (Oxford, England). 2012;22(2):97–103. Scholar
  123. 123.
    Altman AD, Liu XQ, Nelson G, Chu P, Nation J, Ghatage P. The effects of anemia and blood transfusion on patients with stage III-IV ovarian cancer. Int J Gynecol Cancer : Official Journal of the International Gynecological Cancer Society. 2013;23(9):1569–76. Scholar
  124. 124.
    Warner LL, Dowdy SC, Martin JR, Lemens MA, McGree ME, Weaver AL, et al. The impact of perioperative packed red blood cell transfusion on survival in epithelial ovarian cancer. International Journal of Gynecological Cancer : Official Journal of the International Gynecological Cancer Society. 2013;23(9):1612–9. Scholar
  125. 125.
    • Nadeem R, Turkman B, Cha M. Impact of perioperative blood transfusion on survival among women with breast Cancer. Am J Ther. 2017. This meta-analysis evaluates the impact of perioperative transfusions and malignancy progression in breast cancer patients.
  126. 126.
    Paulino Pereira NR, Beks RB, Janssen SJ, Harris MB, Hornicek FJ, Ferrone ML, et al. Are allogeneic blood transfusions associated with decreased survival after surgical treatment for spinal metastases? Spine J : Official Journal of the North American Spine Society. 2016;16(8):951–61. Scholar
  127. 127.
    Janssen SJ, Braun Y, Ready JE, Raskin KA, Ferrone ML, Hornicek FJ, et al. Are allogeneic blood transfusions associated with decreased survival after surgery for long-bone metastatic fractures? Clin Orthop Relat Res. 2015;473(7):2343–51. Scholar
  128. 128.
    Cata JP, Klein EA, Hoeltge GA, Dalton JE, Mascha E, O'Hara J, et al. Blood storage duration and biochemical recurrence of cancer after radical prostatectomy. Mayo Clin Proc. 2011;86(2):120–7. Scholar
  129. 129.
    Kaufman RM, Djulbegovic B, Gernsheimer T, Kleinman S, Tinmouth AT, Capocelli KE, et al. Platelet transfusion: a clinical practice guideline from the AABB. Ann Intern Med. 2015;162(3):205–13. Scholar
  130. 130.
    Goubran HA, Burnouf T, Radosevic M, El-Ekiaby M. The platelet-cancer loop. Eur J Intern Med. 2013;24(5):393–400. Scholar
  131. 131.
    Kaido T, Takada Y, Egawa H, Uemoto S. The influence of intraoperative homologous blood transfusion on prognosis after liver transplantation for hepatocellular carcinoma. Hepato-Gastroenterology. 2009;56(91–92):808–12.PubMedGoogle Scholar
  132. 132.
    Barnett CC Jr, Beck AW, Holloway SE, Kehler M, Schluterman MK, Brekken RA, et al. Intravenous delivery of the plasma fraction of stored packed erythrocytes promotes pancreatic cancer growth in immunocompetent mice. Cancer. 2010;116(16):3862–74. Scholar
  133. 133.
    Kaibori M, Saito T, Matsui K, Yamaoka M, Kamiyama Y. Impact of fresh frozen plasma on hepatectomy for hepatocellular carcinoma. Anticancer Res. 2008;28(3B):1749–55.PubMedGoogle Scholar
  134. 134.
    Tomimaru Y, Wada H, Marubashi S, Kobayashi S, Eguchi H, Takeda Y, et al. Fresh frozen plasma transfusion does not affect outcomes following hepatic resection for hepatocellular carcinoma. World J Gastroenterol. 2010;16(44):5603–10.CrossRefGoogle Scholar
  135. 135.
    Nakaseko Y, Haruki K, Shiba H, Horiuchi T, Saito N, Sakamoto T, et al. Impact of fresh frozen plasma transfusion on postoperative inflammation and prognosis of colorectal liver metastases. J Surg Res. 2018;226:157–65. Scholar
  136. 136.
    Shiba H, Misawa T, Fujiwara Y, Futagawa Y, Furukawa K, Haruki K, et al. Negative impact of fresh-frozen plasma transfusion on prognosis of pancreatic ductal adenocarcinoma after pancreatic resection. Anticancer Res. 2013;33(9):4041–7.PubMedGoogle Scholar
  137. 137.
    Munoz M, Gomez-Ramirez S, Martin-Montanez E, Auerbach M. Perioperative anemia management in colorectal cancer patients: a pragmatic approach. World J Gastroenterol. 2014;20(8):1972–85. Scholar
  138. 138.
    Ludwig H, Muldur E, Endler G, Hubl W. Prevalence of iron deficiency across different tumors and its association with poor performance status, disease status and anemia. Ann Oncol : Official Journal of the European Society for Medical Oncology. 2013;24(7):1886–92. Scholar
  139. 139.
    Ludwig H, Evstatiev R, Kornek G, Aapro M, Bauernhofer T, Buxhofer-Ausch V, et al. Iron metabolism and iron supplementation in cancer patients. Wien Klin Wochenschr. 2015;127:907–19. Scholar
  140. 140.
    Okuyama M, Ikeda K, Shibata T, Tsukahara Y, Kitada M, Shimano T. Preoperative iron supplementation and intraoperative transfusion during colorectal cancer surgery. Surg Today. 2005;35(1):36–40. Scholar
  141. 141.
    Keeler BD, Simpson JA, Ng S, Tselepis C, Iqbal T, Brookes MJ, et al. The feasibility and clinical efficacy of intravenous iron administration for preoperative anaemia in patients with colorectal cancer. Colorectal Dis : the Official Journal of the Association of Coloproctology of Great Britain and Ireland. 2014;16(10):794–800. Scholar
  142. 142.
    Borstlap WA, Stellingwerf ME, Moolla Z, Musters GD, Buskens CJ, Tanis PJ, et al. Iron therapy for the treatment of preoperative anaemia in patients with colorectal carcinoma: a systematic review. Colorectal Dis : the Official Journal of the Association of Coloproctology of Great Britain and Ireland. 2015;17(12):1044–54. Scholar
  143. 143.
    Borstlap WAA, Buskens CJ, Tytgat K, Tuynman JB, Consten ECJ, Tolboom RC, et al. Multicentre randomized controlled trial comparing ferric(III)carboxymaltose infusion with oral iron supplementation in the treatment of preoperative anaemia in colorectal cancer patients. BMC Surg. 2015;15:78. Scholar
  144. 144.
    Wilson MJ, Dekker JWT, Harlaar JJ, Jeekel J, Schipperus M, Zwaginga JJ. The role of preoperative iron deficiency in colorectal cancer patients: prevalence and treatment. Int J Color Dis. 2017;32(11):1617–24. Scholar
  145. 145.
    Dixon E, Datta I, Sutherland FR, Vauthey JN. Blood loss in surgical oncology: neglected quality indicator? J Surg Oncol. 2009;99(8):508–12. Scholar
  146. 146.
    Goodnough LT, Brecher ME, Kanter MH, AuBuchon JP. Transfusion medicine. Second of two parts--blood conservation. N Engl J Med. 1999;340(7):525–33. Scholar
  147. 147.
    Goldschlag B, Afzal N, Carter HB, Fleisher LA. Is preoperative donation of autologous blood rational for radical retropubic prostatectomy? J Urol. 2000;164(6):1968–72.CrossRefGoogle Scholar
  148. 148.
    Meybohm P, Choorapoikayil S, Wessels A, Herrmann E, Zacharowski K, Spahn DR. Washed cell salvage in surgical patients: a review and meta-analysis of prospective randomized trials under PRISMA. Medicine. 2016;95(31):e4490. Scholar
  149. 149.
    Waters JH, Yazer M, Chen YF, Kloke J. Blood salvage and cancer surgery: a meta-analysis of available studies. Transfusion. 2012;52(10):2167–73. Scholar
  150. 150.
    •• Zaw AS, Bangalore Kantharajanna S, Kumar N. Is autologous salvaged blood a viable option for patient blood management in oncologic surgery? Transfus Med Rev. 2017;31(1):56–61. This meta-analysis evaluates the impact of intraoperative blood salvage on cancer recurrence and survival. CrossRefPubMedGoogle Scholar
  151. 151.
    Sanders G, Coker AO, Mellor NJ, Richards K, Rushton AR, Christie I, et al. Acute normovolaemic haemodilution in colorectal surgery. European Journal of Surgical Oncology : the Journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology. 2002;28(5):520–2.CrossRefGoogle Scholar
  152. 152.
    Terai A, Terada N, Yoshimura K, Ichioka K, Ueda N, Utsunomiya N, et al. Use of acute normovolemic hemodilution in patients undergoing radical prostatectomy. Urology. 2005;65(6):1152–6. Scholar
  153. 153.
    Habler O, Schwenzer K, Zimmer K, Prager M, Konig U, Oppenrieder K, et al. Effects of standardized acute normovolemic hemodilution on intraoperative allogeneic blood transfusion in patients undergoing major maxillofacial surgery. Int J Oral Maxillofac Surg. 2004;33(5):467–75. Scholar
  154. 154.
    Jarnagin WR, Gonen M, Maithel SK, Fong Y, D'Angelica MI, Dematteo RP, et al. A prospective randomized trial of acute normovolemic hemodilution compared to standard intraoperative management in patients undergoing major hepatic resection. Ann Surg. 2008;248(3):360–9. Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Ruben D. Agudelo-Jimenez
    • 1
    • 2
  • Juliana A. Heatter
    • 1
    • 2
  • Juan P. Cata
    • 1
    • 2
    Email author
  1. 1.Department of Anesthesiology and Perioperative Medicine, Unit 409The University of Texas –MD Anderson Cancer CenterHoustonUSA
  2. 2.Anesthesiology and Surgical Oncology Research GroupHoustonUSA

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