Autologous blood transfusion for esophageal cancer treated with chemoradiotherapy followed by esophagectomy

Purpose : Autologous blood transfusion has been shown to be useful as a means of avoiding the problems associated with allogeneic transfusion, such as transmission of bacteria and viruses, and immunological reactions, such as allergy, graft-versus-host disease, and suppression of tumor immunity. This study retrospectively investigated the usefulness of autologous blood donation in esophageal cancer treated by chemoradiotherapy (CRT) followed by surgery. Patients and Methods : Between June 2000 and October 2003, 59 patients with resectable esophageal cancer were treated by preoperative CRT, consisting of 5FU 700-800mg/m² days 1-5, Nedaplatin 80mg/m² (or Cisplatin 70mg/m²) day 1, and 30Gy of radiation days 1-19. The criteria for autologous blood donation were : Hb value greater than 11g/dl, body weight greater than 40kg, and having obtained informed consent in writing. Autologous blood was collected 1 and 2 weeks before surgery, and erythropoietin was injected on the day of each blood donation. Esophagectomy was performed by right thoracotomy and laparotomy, and a cervical or intrathoracic anastomosis was created between the esophagus and gastric tube by the stapling technique. The autologous blood donor (ABD) group was compared with a non-autologous blood donor (NABD) group who were treated by the same preoperative CRT schedule and satisfied the criteria for autologous blood donation between Aug 1998 and May 2000. Results : The Hb value of 49 (83.1%) of the 59 patients treated by preoperative CRT was higher than 11g/dl, and 400-800ml (mean 662.2 ± 158.5ml) of autologous blood was successfully collected from the 45 patients (76.3%) who weighed more than 40kg. Allogeneic blood transfusion during the perioperative period was avoided in only 1 patient (9.1%) in the NABD group. In the ABD group, on the other hand, allogeneic blood products, including MAP, FFP and PPF, were avoided in 36 patients (83.7%). There were no significant differences between the two groups in postoperative complications or Hb, serum total protein, and albumin values. Conclusion : These results indicate that autologous blood donation is useful as a means of avoiding allogeneic blood transfusion in esophageal cancer patients treated by preoperative CRT and surgery.