Cuestiones a resolver:
- ¿Cuál es el impacto de la transfusión preoperatoria en la reducción de riesgo cardiovascular?
- ¿Tiene la anemia preoperatoria un impacto en el incremento de riesgo cardiovascular o en la morimortalidad en general?
- ¿Cuáles serían los criterios apropiados para decidir una transfusión en el paciente adulto mayor en el preoperatorio?
Para cada comentario emitido por los médicos residentes, espero la sustentación con bibliografía apropiada.
Correlation Between Perioperative Blood Transfusion and Prognosis of Patients Subjected to Surgery for Stage I Lung Cancer*
ResponderEliminarMario Nosotti, MD, Paolo Rebulla, MD, Donatella Riccardi, MD, Alessandro Baisi, MD, Nadia Bellaviti, MD, Lorenzo Rosso, MD and Luigi Santambrogio, MD
+ Author Affiliations
*From the Thoracic Surgery Unit (Drs. Nosotti, Baisi, Bellaviti, Rosso, and Santambrogio), Centro Trasfusionale e di Immunologia dei Trapianti (Drs. Rebulla and Riccardi), I.R.C.C.S. Ospedale Maggiore Policlinico, Milan, Italy.
Correspondence to: Mario Nosotti, MD, Thoracic Surgery Unit, Ospedale Maggiore Policlinico, I.R.C.C.S. Via F. Sforza, 35, 20122 Milan, Italy; e-mail: marionosotti@libero.it
Abstract
Background: It has been reported, but not proven, that perioperative blood transfusions have a detrimental effect on the survival of patients undergoing surgery for lung cancer.
Study design and methods: A prospective study was carried out on the patients undergoing lobectomy for stage I lung cancer at our department from 1995 to 2000. The criteria for exclusion included previous cases of malignancy, autoimmune diseases, and any other relevant comorbidity.
Results: Two hundred eighty-one patients were observed, 24.6% of whom received transfusions. The only significant difference between the transfused and nontransfused patients was their preoperative hemoglobin (Hb) concentration (12.5 ± 1.20 g/dL vs 13.3 ± 1.22 g/dL, p < 0.001). The disease-free interval of the transfused patients was significantly lower than that of the nontransfused patients (53% vs 78% at 73 months, p < 0.005), as was also the case for actuarial survival (52% vs 71% at 73 months, p < 0.02). Blood transfusion was significantly predictive of tumor relapse according to the Cox model adjusted for the T state, preoperative Hb concentration, sex, age, histologic type, and grading (hazard ratio, 2.3; p = 0.017).
Conclusions: Our data show that perioperative blood transfusion is significantly correlated to worse prognosis in patients undergoing surgery for stage I lung cancer.
Como ven un punto en contra de las transfusiones preoperatorias, al menos en cáncer de pulmón. probablemente esté relacionado a inmunomodulación, lo cual puede tener repercusión en otras esferas de la evolución perioperatoria.
ResponderEliminarPor favor visiten este enlace
ResponderEliminarhttp://chestjournal.chestpubs.org/content/115/suppl_2/113S.full.pdf+html?sid=0202c2fe-c62c-42f8-80a0-695e84d51168