Perioperative blood transfusion does not impair survival after partial pancreaticoduodenectomy for periampullary cancer

Background: The aim of this study was to analyse whether perioperative blood transfusions are an independent risk factor for a reduced survival in patients after partial pancreaticoduodenectomy (PD) for periampullary malignancies. Methods: This single-centre retrospective study analysed overall survival (OS) and disease-free survival (DFS) after PD for periampullary malignancies. Patients receiving perioperative blood transfusion were compared to patients receiving no blood transfusion using univariable and multivariable Cox regression analysis and propensity score matched analysis. Results: Between 2010 and 2022, 214 patients were included, 32 of whom received perioperative blood transfusion. Perioperative blood transfusions were associated with lower preoperative hemoglobin levels (p=0.004), higher intraoperative blood loss (p=0.004), longer duration of surgery (p=0.014), and postpancreatectomy hemorrhage (p<0.001). In multivariable analysis, blood transfusions were not an independent risk factor for a reduced OS (OR=1.11, CI: 0.59-2.08, p=0.724) or DFS (OR=0.94, CI: 0.51-1.73, p=0.843). These results were confirmed by propensity matched analysis (OS: OR=0.79, CI: 0.28-2.20, p=0.647; DFS: OR=0.97, CI: 0.46-2.08, p=0.957). Conclusion: Perioperative blood transfusions in patients undergoing PD for periampullary malignancies are not an independent risk factor for reduced OS and DFS. As high intraoperative blood loss and post-pancreatectomy hemorrhage impair survival intraoperative blood loss should be minimized and postpancreatectomy hemorrhage should be prevented.