Abstract 1475P
Background
Recently, several retrospective studies have shown a negative prognostic impact of intraoperative blood loss (IBL) in curative gastrectomy for advanced gastric cancer. However, there was no reliable reports analyzing the prospective cohort in which the patients, the operative procedure, and follow-up were strictly defined by the protocol. The objective of this study was to evaluate the impact of IBL on long-term outcomes using the data of JCOG1001 phase III trial which failed to show survival superiority of bursectomy to non-bursectomy for cT3/4a gastric cancer.
Methods
Of all 1204 cases enrolled in the JCOG1001 trial, 1203 cases were included in this study, except for one case missing a data of IBL. From the tertile of IBL (400ml, 196ml), we divided into three groups; IBL ≥400ml as large blood loss (LBL, n=406), 400ml >IBL ≥200ml as medium blood loss (MBL, n=393), and IBL <200ml as small blood loss (SBL, n=404). The impact of IBL on relapse-free survival (RFS) were evaluated by univariable and multivariable Cox’s regression analyses.
Results
The median (range) IBL were 575 ml (400-3068) in LBL, 283 ml (200-398) in MBL and 110 ml (0-199) in SBL. 3-year RFS in LBL, MBL and SBL were 70.6% (95% CI, 65.7-74.9), 74.8% (70.0-79.0) and 81.7% (77.3-85.2), respectively, which were significantly different among the three groups (p=0.0019). As first recurrent type, hematogenous (liver, lung and bone) recurrence were more frequently observed in LBL and MBL compared to SBL. In the multivariable analysis for RFS, IBL was one of the independent risk factors, together with ECOG performance status (0/1), pStage, and postoperative adjuvant chemotherapy. Comparing with SBL as a reference, hazard ratio of LBL was 1.49 (95% CI, 1.09-2.04, p=0.014) and that of MBL was 1.58 (1.18-2.12, p=0.0024).
Conclusions
Negative impact of IBL on long-term outcome after curative gastrectomy was confirmed by analyzing the data of large-scale prospective study. Surgeons need to make an effort to reduce IBL as much as possible.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
Japan Clinical Oncology Group (JCOG).
Funding
Japan Agency for Medical Research and Development, the Ministry of Health, Labour and Welfare of Japan.
Disclosure
All authors have declared no conflicts of interest.