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World J Surg. 2009 Jun;33(6):1240-6. doi: 10.1007/s00268-009-9979-4.

Intraoperative blood loss is a critical risk factor for peritoneal recurrence after curative resection of advanced gastric cancer.

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  • 1Department of Surgery, Division of Surgical Oncology, University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.



Perioperative blood transfusion has been shown to be associated with poor outcome in various types of malignancy. However, the relationship between the amount of blood loss and specific types of cancer recurrence has not been documented.


We retrospectively examined the amount of intraoperative blood loss and the recurrence pattern in 146 patients who underwent curative gastrectomy for advanced gastric cancer and assessed the possible correlation between intraoperative blood loss and peritoneal, locoregional, and hematogenous recurrences.


The amount of intraoperative blood loss in patients who developed peritoneal recurrence was significantly greater than that in patients without peritoneal recurrence, irrespective of blood transfusion. In contrast, the blood loss was not associated with nodal or hematogenous recurrence. Multivariate analysis demonstrated that large blood loss as well as operative curability B and adjuvant chemotherapy were independent risk factors for peritoneal recurrence and a worse outcome in advanced gastric cancer.


Intraoperative blood loss in curative gastrectomy for advanced gastric cancer may have a specific association with the development of peritoneal recurrence. Surgeons must remember that clean and dry surgery may lessen not only 30-day mortality and morbidity but long-term peritoneal recurrence in gastric cancer.

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