Postoperative Long-term Outcomes of Acute Normovolemic Hemodilution in Pancreatic Cancer: A Propensity Score Matching Analysis

Purpose: Acute normovolemic hemodilution (ANH) is a useful intraoperative blood conservation technique. However, impact on long-term outcomes in pancreatic ductal adenocarcinoma (PDAC) remains unclear. We investigated the impact of ANH on long-term outcomes of PDAC patients undergoing radical surgery. Methods: We collected a dataset from 155 resectable PDAC. Patients were categorized according to whether or not they had received intraoperative allogeneic blood transfusion (ABT) or ANH. Postoperative complications, recurrence-free survival (RFS), and disease-specific survival (DSS), before and after propensity score matching (PSM), were compared among patients who did and did not receive ANH, excluding the ABT cohort. Results: Forty-four (28.4%) were included in the ANH group, and 30 patients (19.4%) in the ABT group; 81 (52.3%) patients, comprising the standard management (STD) group, received neither ANH nor ABT. The ABT group dmonstrated the worst prognosis among them. Before PSM, ANH was significantly associated with decreased RFS (P = 0.043) and DSS (P = 0.029) compared with the STD group. Cox regression analysis identified ANH as an independent prognostic factor for RFS (risk ratio (RR) = 1.696, P = 0.019) and DSS (RR = 1.876, P = 0.009). After PSM, in contrast with short-term outcomes, RFS (median survival time (MST), 12.1 vs. 18.1 months, P = 0.097) and DSS (MST, 32.1 vs. 50.5 months, P = 0.097) in the ANH group were less favorable than those in the STD group. Conclusion: ANH has more potential negative effects on long-term postoperative outcomes in PDAC than STD, though not as negative as ABT.