Autologous and heterologous blood transfusion in head and neck cancer surgery

Objective: To determine if the use of autologous blood ameliorates the increased risk for cancer recurrence that has been associated with perioperative blood transfusion. Design: Retrospective medical record review. Setting: Tertiary care hospital. Patients: One hundred sixty-five consecutive patients with stages II to IV squamous cell carcinoma of the head and neck treated surgically at a university hospital from January 1, 1989, through December 31, 1994. Main Outcome Measures: We evaluated the impact of perioperative autologous and heterologous blood transfusion and 10 other variables on recurrence. Univariate and multivariate analyses were used. Results: Heterologous blood recipients had a 59% recurrence rate, whereas those who had received autologous blood or no transfusion had recurrence rates of 33% and 35%, respectively. The following 4 variables had a statistically significant association with recurrence by multivariate analysis: previous treatment of current malignancy (P<.001); receipt of heterologous blood (P= .04); positive margin (P=.04); and nodal disease (P= .04). The receipt of heterologous blood was associated with a 40% increased risk for recurrence. Conclusion: Autologous blood products should be used during head and neck cancer surgery if possible when transfusion is necessary.