Gastrectomy with radical
lymph node dissection is the most promising treatment avenue for patients with
gastric cancer. However, this procedure sometimes induces excessive intraoperative blood loss and requires perioperative allogeneic
blood transfusion. There are lasting discussions and controversies about whether intraoperative blood loss or perioperative
blood transfusion has adverse effects on the prognosis in patients with
gastric cancer. We reviewed laboratory and clinical evidence of these associations in patients with
gastric cancer. A large amount of clinical evidence supports the correlation between excessive intraoperative blood loss and adverse effects on the prognosis. The laboratory evidence revealed three possible causes of such adverse effects: anti-
tumor immunosuppression, unfavorable postoperative conditions, and peritoneal recurrence by spillage of
cancer cells into the pelvis. Several systematic reviews and meta-analyses have suggested the adverse effects of perioperative
blood transfusions on prognostic parameters such as all-cause mortality, recurrence, and postoperative complications. There are two possible causes of adverse effects of
blood transfusions on the prognosis: Anti-
tumor immunosuppression and patient-related confounding factors (e.g., preoperative
anemia). These factors are associated with a worse prognosis and higher requirement for perioperative
blood transfusions. Surgeons should make efforts to minimize intraoperative blood loss and transfusions during
gastric cancer surgery to improve patients' prognosis.