Transfusion, recurrence, and infection in head and neck cancer surgery

The detrimental effects of transfusion have been documented--particularly by surgical oncologists, who believe transfusion-induced immunosuppression increases the incidence of recurrence and infectious complications. We examined this relation in surgical oncology of the head and neck. After meeting strict inclusion criteria, 104 patients were entered into the study, in which 31 variables of a clinical, surgical, pathologic, laboratory, and treatment nature were studied. Multivariate analysis showed transfusion did not significantly affect recurrence or infectious complications. However, by univariate analysis, infectious complications were related to transfusion (p = 0.029). The variables age (p = 0.024), postoperative hemoglobin level (p = 0.049), and spread to regional lymph node (p = 0.0015) were found to significantly affect the incidence of recurrence. In the three previous otolaryngologic studies, transfusions had been shown to affect recurrence; however, two studies used univariate analysis only. Since this is one of the first otolaryngologic studies to examine the relation of transfusion with infectious complications, prospective studies using multivariate analysis are warranted. Meanwhile, the decision to transfuse should continue to depend on the clinical status of the patient.