Perioperative blood transfusion negatively affects outcomes following surgery for pancreatic neuroendocrine neoplasms

Introduction: Pancreatic neuroendocrine neoplasms (pNEN) are a rare and heterogeneous group of tumors, whose diagnosis, treatment, and research are particularly challenging due to their rarity and biological diversity. While surgical resection remains the primary curative approach for patients with resectable pNEN, the influence of perioperative blood transfusion on surgical and oncological outcomes in this patient population is not well understood.

Objective: This study investigates the relationship between transfusion and perioperative characteristics, postoperative complications and overall survival in pNEN patients.

Methods: Patients undergoing resection for pNEN were identified from a prospectively-maintained database and were stratified by receipt of perioperative blood transfusion vs. no transfusion. Baseline characteristics, intra- and postoperative outcomes and survival data were compared using appropriate statistical tests. Multivariate Cox regression identified independent predictors of overall survival.

Results: 632 patients were included, of whom 57 (9%) received blood transfusion. Transfused patients were significantly older (p=0.026), predominantly male (p<0.001) and had higher ASA scores (p<0.001). In addition, these patients underwent more frequently pancreatic head resection or total pancreatectomy (p<0.001), had greater intraoperative blood loss (p<0.001), longer operative time (p<0.001), larger tumors (p=0.004) and higher Ki-67 indices (p=0.014). Postoperatively, transfused patients experienced more severe pancreatic fistula (POPF grade C; p<0.001) and had an increased rate of R1 resections (p=0.004). On univariate analysis, perioperative transfusion was strongly associated with worse overall survival (HR 3.06; 95% CI 1.89–4.98; p<0.001). In multivariate analysis, transfusion remained an independent risk factor for mortality (HR 1.91; 95% CI 1.05–3.49; p=0.035), together with longer operative time, higher ASA score and lymph-node metastasis.

Conclusions: Perioperative blood transfusion in patients with pNEN undergoing pancreatic surgery is associated with more advanced disease, more extensive resections, increased postoperative morbidity and significantly impaired long-term survival. These findings underscore the need for optimized blood management strategies in pNEN surgery to improve patient outcomes.