Acstract. Background: Excessive blood loss and blood transfusion may influence postoperative complications and prognosis of patients after pancreatic resection. We evaluated the influence of blood products use on postoperative recurrence and outcome of patients with pancreatic ductal

transfusion may influence postoperative complications and prognosis of patients after pancreatic resection. We evaluated the influence of blood products use on postoperative recurrence and outcome of patients with pancreatic ductal adenocarcinoma. Patients and Methods: The study included 82 patients who underwent elective pancreatic resections for pancreatic ductal adenocarcinoma without distant metastasis or other malignancies between January 2001 and December 2010. We retrospectively investigated the influence of the use of perioperative blood products including red cell concentrate, fresh-frozen plasma (FFP), and albumin preparation, and clinical variables regarding disease-free and overall survival. Results: In disease-free survival, serum carcinoembryonic antigen more than 10 ng/ml (p=0.015), serum carbohydrate antigen 19-9 (CA19-9) more than 200 U/ml (p=0.0032), R1 resection (p=0.005), and FFP transfusion were independent risk factors for cancer recurrence in the Cox proportional regression model, pancreaticoduodenectomy (p=0.057) and advanced tumor stage (p=0.083) tended to associate with poor disease-free survival, but were not statistically significant. In overall survival, male gender (p=0.012), advanced tumor stage (p=0.005), serum CA19-9 more than 200 U/ml (p<0.001), and FFP transfusion (p=0.003) were positively associated with poor overall survival in the Cox proportional regression model. Conclusion: FFP transfusion is associated with poor therapeutic outcome after elective pancreatic resection for pancreatic ductal adenocarcinoma. Pancreatic carcinoma is one of the most common malignant cancers worldwide (1). Surgical resection is the only therapeutic strategy that offers potential cure or long-term survival for patients with pancreatic ductal adenocarcinoma. However, the overall survival rate of patients with curative surgical resection remains poor inspite of improvement of surgical techniques, instruments, postoperative management, and chemotherapeutic agents (2-6). Large tumor size, poor differentiation, lymph node involvement, positive resection margin, postoperative morbidity, and perioperative blood transfusion have been identified as poor prognostic factors for long-term survival after pancreatic resection for pancreatic adenocarcinoma (7-14). Recent studies have reported that allogeneic blood transfusion exerts immunomodulatory effects (15-19) and blood transfusion may affect postoperative complications and prognosis of malignancies (20-35). On this regard, reported blood transfusion rates of pancreaticoduodenectomy (PD) for periampullary carcinomas range from 18% to 67% (36-40), and those of distal pancreatectomy (DP) for pancreatic ductal carcinomas range from 30% to 38% (41, 42). In this study, we retrospectively investigated the relation between perioperative allogenic blood transfusion, including red cell concentrate (RC) and fresh-frozen plasma (FFP), and disease-free as well as overall survival, after elective pancreatic resection for pancreatic ductal adenocarcinoma.