Effect of perioperative blood transfusions and infectious complications on inflammatory activation and long-term survival following gastric cancer resection

Background: The aim of this study was to evaluate the impact of perioperative blood transfusion and infectious complications on postoperative changes of inflammatory markers, as well as on disease-free survival (DFS) in patients undergoing curative gastric cancer resection. Methods: Multicenter cohort study in all patients undergoing gastric cancer resection with curative intent. Patients were classified into four groups based on their perioperative course: one, no blood transfusion and no infectious complication; two, blood transfusion; three, infectious complication; four, both transfusion and infectious complication. Neutrophil-to-lymphocyte ratio (NLR) was determined at diagnosis, immediately before surgery, and 10 days after surgery. A multivariate Cox regression model was used to analyze the relationship of perioperative group and dynamic changes of NLR with disease-free survival. Results: 282 patients were included, 181 in group one, 23 in group two, 55 in group three, and 23 in group four. Postoperative NLR changes showed progressive increase in the four groups. Univariate analysis showed that NLR change > 2.6 had a significant association with DFS (HR 1.55; 95% CI 1.06-2.26; p = 0.025), which was maintained in multivariate analysis (HR 1.67; 95% CI 1.14-2.46; p = 0.009). Perioperative classification was an independent predictor of DFS, with a progressive difference from group one: group two, HR 0.80 (95% CI: 0.40-1.61; p = 0.540); group three, HR 1.42 (95% CI: 0.88-2.30; p = 0.148), group four, HR 2.85 (95% CI: 1.64-4.95; p = 0.046). Conclusions: Combination of perioperative blood transfusion and infectious complications following gastric cancer surgery was related to greater NLR increase and poorer DFS. These findings suggest that perioperative blood transfusion and infectious complications may have a synergic effect creating a pro-inflammatory activation that favors tumor recurrence

Ictericia obstructiva neoplásica. Tratamiento paliativo con prótesis metálica autoexpandible

Objetivo: estudio de la incidencia de complicaciones y la efectividad del tratamiento paliativo con prótesis biliar frente a cirugía paliativa en pacientes con ictericia obstructiva neoplásica. Diseño experimental: revisión retrospectiva. Pacientes: 35 pacientes con ictericia neoplásica considerados irresecables en los que se colocó prótesis biliar percutánea (neoplasia de cabeza de páncreas. n= 11: colangiocarcinoma. n= 11; neoplasia de vesícula biliar. n=4; y recidiva o metástasis de neoplasia no bilio-pancreática. n=8). Grupo control: 23 pacientes con intervención qu1rurgica paliativa de ictericia neoplásica. Resultados: las complicaciones más frecuentes fueron la colangitis y la obstrucción de la prótesis. La estancia media tras. la colocación fue de 6.8 días. siendo mayor en los pacientes que presentaron complicaciones {p=0,035). Un 22. 9% presentó recurrencia de la ictericia y el reingreso se produjo en 4 2, 9% de los pacientes. La superviviencia media fue de 163,33 días (rango 19-522). El descenso de bilirrubina tras la colocación fue significativo (215 vs. 82 mmol/I, p< 0.001). Conclusiones: comparando con nuestra experiencia previa en c1rug1a pahattva. no hay diferencias significativas en morbimortalidad. recurrencia ni reingresos. Los pacientes afectos de colangiocarcinoma hiliar y cáncer de cabeza de páncreas se benefician de una menor estancia post-tratamiento