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The Importance of Blood Loss During Colon Cancer Surgery for Long-Term Survival: An Epidemiological Study Based on a Population Based Register

Mörner, Malin E. M. MD*; Gunnarsson, Ulf PhD*; Jestin, Pia PhD; Svanfeldt, Monika PhD*

doi: 10.1097/SLA.0b013e3182512df0
Original Articles

Objective: This study tested the hypothesis that the amount of blood loss during surgery for colonic cancer influences long-term survival.

Background: The perioperative blood loss during surgery for colorectal cancer relates to the risk for complications and early mortality.

Methods: All patients who underwent surgery for colon cancer between 1997 and 2003 in the health-care region of Uppsala/Örebro were prospectively registered at the regional oncological center. Data on patients who underwent radical surgery for stages I to III disease were analyzed. Patients who died within 6 months after surgery were excluded. Hazard ratios were calculated with uni- and multivariate Cox proportional hazard regression. Because of covariation, blood loss, blood transfusion, and complications were tested in separate multivariate analyses.

Results: Blood loss of 250 mL or more during surgery, male gender, occurrence of complications, age more than 75 years, and stage III disease were risk factors for overall mortality in the uni- and multivariate analyses. Perioperative blood transfusion was shown to be a risk factor in the univariate analysis only.

Conclusions: The results support the hypothesis that degree of blood loss during surgery for colon cancer is a factor that influences long-term survival.

This epidemiological population-based study, including 3062 patients, indicates that blood loss of 250 mL or more during surgery for colon cancer reduces long-term survival.

*From the Division of Surgery, Department for Clinical Science, Intervention and Technology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden

Department of Surgical Sciences, University Hospital, Uppsala, Sweden.

Reprints: Malin Mörner, MD, Karolinska University Hospital, 141 86 Stockholm, Sweden. E-mail:

Disclosure: No conflicts of interest have been reported. The study received financial support from the Karolinska Institute, Stockholm County Council (ALF, grant number 20100123) and the Bengt Ihre Foundation.

© 2012 Lippincott Williams & Wilkins, Inc.