Effect of perioperative blood transfusion (BTF) on elderly gastric cancer patients

We thank Dr. Zhang et al. (1) for their comments on our study regarding the impact of perioperative blood transfusion (BTF) on postoperative complications and prognosis in elderly patients with gastric cancer, published in the Journal of Gastrointestinal Oncology. Randomization is an effective method to reduce confounding factors among groups, but it is commonly used in prospective studies (2). Our study was a retrospective study, and randomization could not be performed.

In our study, the median follow-up time was only 51 months. However, as of our follow-up date, 63.5% (1,057) of the patients had either died or had been followed up for more than five years. Therefore, it still holds some value as an assessment of long-term outcomes. Of course, we fully agree with Dr. Zhang et al.’s suggestion to continue with longer follow-up to provide more accurate results.

Considering the impact of intraoperative bleeding on prognosis, we grouped the cases based on the cut-off value (300 mL) referenced in previous studies (3). Multiple studies have reported that there is no significant difference in prognosis and complications between laparoscopic and open surgery for gastric cancer patients, hence we did not deem it necessary to perform a stratified analysis based on the surgical approach (4-6).

In our study, 411 patients received BTFs, while only 64 patients received red blood cells (RBCs) alone. The remaining patients received a combination of RBCs and other blood components such as plasma. Due to the small number of patients who received single-component transfusions, further stratified analysis was not feasible. Previous studies on the effects of transfusion volume, timing, and components on prognosis have already been listed in the discussion section of our original text (7). If conditions permit in the future, we will consider conducting a multi-center study to increase the sample size, reduce potential biases, and perform more detailed stratified analyses to obtain more precise results.

Acknowledgments

Funding: This study was supported by a grant from the National Natural Science Foundation of China (No. 8207101617).

Footnote

Provenance and Peer Review: This article was commissioned by the editorial office, Journal of Gastrointestinal Oncology. The article did not undergo external peer review.

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jgo.amegroups.com/article/view/10.21037/jgo-24-487/coif). All authors report that this study was supported by a grant from the National Natural Science Foundation of China (No. 8207101617). The authors have no other conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

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