Evidence map›Paper›PMID 41110023›Full record

ArticleAnnals of surgical oncology2026

Preoperative Anemia, Transfusion, and Long-Term Oncologic Outcomes after Gastrectomy: Findings from the POWER4 Cohort.

Javier Ripollés-Melchor, Ane Abad-Motos, José A García-Erce, Carlos Jericó, Ángel V Espinosa, María J Colomina, Alfredo Abad-Gurumeta, Margarita Logroño-Ejea, Patricia Galán-Menéndez, Andrés Zorrilla-Vaca and 16 more

Erratum issuedAbstract readMulticenter Study
PubMed Publisher
In one paragraph

Article in Annals of surgical oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

26 authors.

Javier Ripollés-MelchorDepartment of Anaesthesia and Critical Care, Infanta Leonor University Hospital, Madrid, Spain. ripo542@gmail.com.
Ane Abad-MotosDepartment of Anaesthesia and Critical Care, Donostia University Hospital, Donostia-San Sebastian, Spain.
José A García-ErceBlood and Tissue Bank of Navarra, Servicio Navarro de Salud, Osasunbidea, Pamplona, Spain.
Carlos JericóGrupo Multidisciplinar para el Estudio y Manejo de la Anemia del Paciente Quirúrgico, Zaragoza, Spain.
Ángel V EspinosaDepartment of Anaesthesia and Critical Care, Froedtert Hospital Medical College of Wisconsin, Milwaukee, WI, USA.
María J ColominaFluid Therapy and Hemodynamic Monitoring Working Group, Spanish Society of Anaesthesia and Critical Care, Madrid, Spain.
Alfredo Abad-GurumetaDepartment of Anaesthesia and Critical Care, Infanta Leonor University Hospital, Madrid, Spain.
Margarita Logroño-EjeaDepartment of Anaesthesia and Critical Care, Araba University Hospital, Araba, Spain.
Patricia Galán-MenéndezFluid Therapy and Hemodynamic Monitoring Working Group, Spanish Society of Anaesthesia and Critical Care, Madrid, Spain.
Andrés Zorrilla-VacaAnesthesiology, Perioperative and Pain Medicine Department, Brigham and Women's Hospital, Boston, MA, USA.
Astrid BatallaDepartment of Anaesthesia and Critical Care, Sant Pau University Hospital, Barcelona, Spain.
Raquel Fernández-GarcíaDepartment of Anaesthesia and Critical Care, Móstoles University Hospital, Móstoles, Spain.
Gloria Paseiro-CrespoDepartment of Surgery, Infanta Leonor University Hospital, Madrid, Spain.
Raquel García-ÁlvarezDepartment of Anaesthesia and Critical Care, 12 de Octubre University Hospital, Madrid, Spain.
Nekari de-Luis-CabezónDepartment of Anaesthesia and Critical Care, Basurto University Hospital, Bilbao, Spain.
Ana León-BretscherDepartment of Surgery, Infanta Leonor University Hospital, Madrid, Spain.
María García-NebredaDepartment of Surgery, Infanta Leonor University Hospital, Madrid, Spain.
Héctor Bergés-GutierrezDepartment of Anaesthesia and Critical Care, Virgen de la Macarena University Hospital, Sevilla, Spain.
Alicia Ruiz-EscobarDepartment of Anaesthesia and Critical Care, Infanta Leonor University Hospital, Madrid, Spain.
José L Rábago-MoriyónDepartment of Anaesthesia and Critical Care, Marqués de Valdecilla University Hospital, Santander, Spain.
Leticia Gómez-VianaDepartment of Anaesthesia and Critical Care, Complexo Hospitalario Universitario de Ourense, Ourense, Spain.
Lucía Gil-GómezDepartment of Anaesthesia and Critical Care, Complex Hospitalari Universitari Moisès Broggi, Sant Joan Despí, Spain.
Silvia Gil-TrujilloDepartment of Anaesthesia and Critical Care, Ciudad Real University Hospital, Madrid, Spain.
María J Maroño-BoeDepartment of Anaesthesia and Critical Care, Cruces University Hospital, Bilbao, Spain.
César AldecoaComplutense University, Madrid, Spain.
POWER4 Investigators

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundPreoperative anemia and transfusion are common in gastric cancer surgery and have been associated with adverse short-term outcomes. Their impact on long-term oncologic prognosis remains unclear. We aimed to assess the association between preoperative anemia, perioperative red blood cell transfusion, and disease-free survival (DFS) after gastrectomy. PATIENTS AND

methodsThis was a prespecified long-term analysis of the prospective POWER4 multicenter cohort conducted across 72 Spanish hospitals. Patients undergoing elective gastrectomy for gastric cancer between 2019 and 2020 were followed for ≥ 36 months. DFS was defined as time from surgery to recurrence or death. Primary exposures were preoperative anemia (World Health Organization criteria) and perioperative transfusion (within 72 h). Analyses included Kaplan-Meier estimates, multivariable Cox regression, logistic regression for delayed or omitted adjuvant chemotherapy (RIOT), and causal mediation analysis. Generalized additive models (GAMs) explored nonlinear associations between hemoglobin and DFS.

resultsAmong 386 patients, 47% had anemia and 28% received transfusion. In 368 with complete follow-up, DFS event rates ranged from 13% (no anemia/no transfusion) to 38% (anemia + transfusion) (p < 0.001). Both exposures were associated with DFS in univariable models but lost significance after adjustment. No hemoglobin threshold was identified. Among 149 eligible patients, RIOT was delayed or omitted in 41%, with neither exposure as independent predictors. Mediation analysis suggested transfusion explained 26% of the effect of anemia on DFS, though not significantly.

conclusionsAnemia and transfusion were associated with adverse unadjusted outcomes, but not independently. This supports interpreting anemia as a marker of vulnerability rather than a modifiable risk factor for recurrence.

Indexed as

AnemiaBlood TransfusionErythrocyte TransfusionGastrectomyNeoplasm Recurrence, LocalStomach NeoplasmsAgedFemaleFollow-Up StudiesHumansMaleMiddle AgedPrognosisProspective StudiesSurvival RateBlood transfusionDisease-free survivalGastrectomyGastric cancerPatient blood managementPreoperative anemia

Identifiers

PMID41110023

What OpenQuestion holds

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.