Use of Packed Red Blood Cells after Laparoscopic and Open Resection for Colorectal Tumors. A Case-Matched Study on 620 Patients

Background: Advantages of laparoscopic surgery over open approach include earlier recovery, less depletion of the systemic immune function and less intraoperative blood loss. RCTs comparing laparoscopic and open resection for colorectal cancer (CRC) demonstrated a reduced blood loss of 70-100 mL in favor of minimally invasive surgery. Nonetheless, little data are available on the use of red blood cell (RBC) transfusions after laparoscopic and open CRC resection. The hypothesis of this case-matched study is that postoperative RBC requirement in patients undergoing elective resection for CRC is lower after laparoscopic compared to open surgery Materials and Methods: Data from 310 patients undergoing laparoscopic surgery for CRC at the Division of General and Hepatobiliary Surgery, University of Verona Hospital Trust, between Apr 2013 and Dec 2017, were compared with data from 310 patients selected by case matching among 1108 patients undergoing open surgery between Jan 2005 and Dec 2017. Transfusion history included all data on RBCs transfused between 30 days before and 90 days after surgery. Results: Among the 1418 patients included in the dataset, 364 (25.7%) received one or more postoperative RBC transfusion, for a total number of units of 1234, a mean(SD) number of 0.9(2.0) units when considering the whole cohort and, a mean(SD) number of 3.4(2.8) units when considering transfused patients only. When matching laparoscopic and open cases for age and gender, the percentage of postoperatively transfused patients was doubled after open resection (26.1% vs. 15.8%; p<0.05). The total number of transfused RBC units was significantly higher after open surgery (353 vs. 180; p<0.01), while the mean(SD) number of units for transfused patients was comparable between the two groups [4.4 (3.7) vs 3.7 (3.4); p = 0.79]. Considering clinic-pathological variables, a significant difference was observed in R-category (p<0.01), pT (p<0.01), pN (p<0.01), M (p<0.01), preoperative Hb level (p<0.05) and preoperative RBC transfusion (p<0.05). Conversely, no differences were demonstrated for tumor location (p=0.87) and extent of surgery (p=0.55). When age, gender, extent of resection, R-category, pT, pN and M classes and preoperative Hb levels were used for case-matching, the percentage of patients requiring postoperative transfusion was comparable between open and laparoscopic surgery (18.1% vs. 15.8%; p=0.85). Similarly, the total number of transfused RBC units (174 vs. 180; p=0.86), the mean(SD) number of units in all the cohort [0.6(1.5) vs. 0.6(1.9); p=0.47] and the mean (SD) number of units in transfused patients only [3.1(3.3) vs. 3.7(3.5); p=0.86] were comparable between open and laparoscopic cases. Conclusions: Laparoscopic compared to open resection for CRC failed to demonstrate a lower requirement of RBC transfusions after case-matching for main clinic-pathological variables