The Relationship of Perioperative Blood Transfusion With Bladder Cancer Mortality In Radical Cystectomy Patients

Aria Utama Nur Qohari, Ahmad Zulfan Hendri


Background: Perioperative blood transfusion is correlated to adverse effects which lead to mortality on a few cases of patients with malignancy, especially kidney tumors. The objective of this study is to evaluate the relationship between blood transfusion timings and survival of patients with bladder cancer who undergo radical cystectomy and measure the differences in the outcomes between patients undergoing intraoperative blood transfusion and patients undergoing blood transfusion after surgery.

Methods: This research is a retrospective analytic study with a cohort design. Thirty patients with bladder tumors who performed radical cystectomy and did not undergo perioperative
chemotherapy were included in the study data. Recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS) were analyzed by the Kaplan-Meier method and compared between groups with log-rank tests. Chi-square test was used for comparative evaluation of each group. Univariate and multivariate analyzes were performed to evaluate the relationship between clinical and pathological variables with risks such as RFS, CSS, and OS. P<.005 were considered statistically significant, and SPSS software was used for the entire analysis process.

Results: From a total of 29 patients who had a radical cystectomy, 22 patients received perioperative blood transfusion. The 17 patients had the transfusion intraoperatively while the rest had the transfusion after the operation. The mean of blood loss was 1491 cc and the mean of survival was 13.2 months. Intraoperative blood transfusion was associated with a significantly increased risk of disease recurrence (HR: 1.32; P=.034), bladder cancer mortality (HR: 1.65; P=.015), and all-cause mortality (HR: 12.38; P=.013).

Conclusions: Intraoperative blood transfusion is significantly associated with an increased risk of cancer mortality. Further investigation is needed to determine the biological mechanisms
underlying patient outcomes.


bladder cancer, radical cystectomy, blood transfusion, mortality


Kluth LA, Xylinas E, Rieken M, et al. Impact of perioperative blood transfusion on the outcome of patients undergoing radical cystectomy for urothelial carcinoma of the bladder. BJU Int 2014;113(3):393–8.

Vricella GJ, Finelli A, Alibhai SM, Ponsky LE, Abouassaly R. The true risk of blood transfusion after nephrectomy for renal masses: a population-based study. BJU Int. 2013;111(8):1294–300.

Vamvakas EC, Blajchman MA. Transfusion-related immunomodulation (TRIM): an update. Blood Rev. 2007;21(6):327–48.

Blumberg N, Heal JM. Effects of transfusion on immune function. Cancer recurrence and infection. Arch Pathol Lab Med 1994;118(4):371–9.

Linder BJ, Frank I, Cheville JC, et al. The impact of perioperative blood transfusion on cancer recurrence and survival following radical cystectomy. Eur Urol. 2013;63(5):839–45.

Morgan TM, Barocas DA, Chang SS, et al. The relationship between perioperative blood transfusion and overall mortality in patients undergoing radical cystectomy for bladder cancer. Urol Oncol. 2013;31(6):871–7.

Wang CC, Iyer SG, Low JK et al. Perioperative factors affecting long-term outcomes of 473 consecutive patients undergoing hepatectomy for hepatocellular carcinoma. Ann Surg Oncol 2009;16(7):1832–42.

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.

Cho H-J, Kim SJ, HaU-S, HongS-H, Kim JC, Choi Y-J, et al. Prognostic value of capsular invasion for localized clear-cell renal cell carcinoma. Eur Urol. 2009;56(6):1006–12.

Al-Refaie WB, Parsons HM, Markin A, Abrams J, Habermann EB. Blood transfusion and cancer surgery outcomes: a continued reason for concern. Surgery. 2012;152(3):344–54.

Tartter PI. Blood transfusion and infectious complications following colorectal cancer surgery. Br J Surg. 1988;75(8):789–92.

Van Twuyver E, Mooijaart RJ, ten Berge IJ, et al. Pretransplantation blood transfusion revisited. N Engl J Med. 1991;325(17):1210–3.

Jensen LS, Andersen AJ, Christiansen PM, et al. Postoperative infection and natural killer cell function following blood transfusion in patients undergoing elective colorectal surgery. Br J Surg. 1992;79(6):513–6.

Berezina TL, Zaets SB, Morgan C, et al. Influence of storage on red blood cell rheological properties. J Surg Res. 2002;102(1):6–12.

Vamvakas EC. Possible mechanisms of allogeneic blood transfusion-associated postoperative infection. Transfus Med Rev. 2002;16(2):144–60.

Hogan BV, Peter MB, Shenoy HG, Horgan K,Hughes TA. Surgery induced immunosuppression. Surgeon. 2011;9(1):38-43.

Manjuladevi M, Upadhyaya KSV. Perioperative blood management. Indian J Anaesth. 2014; 58(5):573-580.

Mina SH, Garcia-Perdomo HA. Effectiveness of tranexamic acid for decreasing bleeding in prostate surgery: a systematic review and meta-analysis. Cent European J Urol. 2018;71(1):72-7.

Wuethrich PY, Burkhard FC, Thalmann GN, Stueber S, Studer UE. Restrictive deferred hydration combined with preemptive norepinephrine infusion during radical cystectomy reduces postoperative complications and hospitalization time: a randomized clinical trial. Anesthesiology 2014;120(2):365–77.

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DOI: 10.33371/ijoc.v14i3.693

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