Predictors of intraoperative blood loss in patients undergoing hepatectomy
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Despite recent advances in surgical techniques, blood loss can still determine the postoperative outcome of hepatectomy. Thus, the preoperative identification of risk factors predicting increased blood loss is important.
We studied retrospectively the clinical records of 482 patients who underwent elective hepatectomy for liver disease, and analyzed the clinicopathological and surgical parameters influencing intraoperative blood loss.
Red cell transfusion was required for 165 patients (35 %). Based on blood transfusion requirement and hepatic failure, we estimated predictive cut-off values at 850 and 1500 ml. The factors found to be significantly associated with increased blood loss were as follows: male gender, obstructive jaundice, non-metastatic liver carcinoma, Child-Pugh B disease, decreased uptake ratio on liver scintigraphy, platelet count, or prothrombin activity, longer hepatic transection time, operating time, the surgeon’s technique, J-shape or median incision, major hepatectomy, and not using hemostatic devices (p < 0.05). Multivariate analysis identified male gender, low prothrombin activity, longer transection time, longer operation time, and not using hemostatic devices as factors independently associated with increased blood loss (p < 0.05).
Male gender and low prothrombin activity represent risk factors for increased blood loss during hepatectomy. Moreover, every effort should be made to reduce the transection and operating times using the latest hemostatic devices.
- Sharma R, Gibbs JF. Recent advances in the management of primary hepatic tumors refinement of surgical techniques and effect on outcome. J Surg Oncol. 2010;101:745–54. CrossRef
- Furrer K, Deoliveira ML, Graf R, Clavien PA. Improving outcome in patients undergoing liver surgery. Liver Int. 2007;27:26–39. CrossRef
- Sima CS, Jarnagin WR, Fong Y, et al. Predicting the risk of perioperative transfusion for patients undergoing elective hepatectomy. Ann Surg. 2009;250:914–21. CrossRef
- Katz SC, Shia J, Liau KH, Gonen M, Ruo L, Jarnagin WR, et al. Operative blood loss independently predicts recurrence and survival after resection of hepatocellular carcinoma. Ann Surg. 2009;249:617–23. CrossRef
- Fujiwara Y, Shiba H, Furukawa K, Iida T, Haruki K, Gocho T, et al. Glasgow prognostic score is related to blood transfusion requirements and post-operative complications in hepatic resection for hepatocellular carcinoma. Anticancer Res. 2010;30:5129–36.
- Hsu KY, Chau GY, Lui WY, Tsay SH, King KL, Wu CW. Predicting morbidity and mortality after hepatic resection in patients with hepatocellular carcinoma: the role of Model for End-Stage Liver Disease score. World J Surg. 2009;33:2412–9. CrossRef
- Kamiyama T, Nakanishi K, Yokoo H, Kamachi H, Tahara M, Yamashita K, et al. Perioperative management of hepatic resection toward zero mortality and morbidity: analysis of 793 consecutive cases in a single institution. Am Coll Surg. 2010;211:443–9. CrossRef
- Kusano T, Sasaki A, Kai S, Endo Y, Iwaki K, Shibata K, et al. Predictors and prognostic significance of operative complications in patients with hepatocellular carcinoma who underwent hepatic resection. Eur J Surg Oncol. 2009;35:1179–85. CrossRef
- Nanashima A, Sumida Y, Abo T, Nagasaki T, Takeshita H, Fukuoka H, et al. Patient outcome and prognostic factors in intrahepatic cholangiocarcinoma after hepatectomy. Hepatogastroenterology. 2007;54:2337–42.
- Nanashima A, Sumida Y, Abo T, Tanaka K, Takeshita H, Hidaka S, et al. Clinicopathological and intraoperative parameters associated with postoperative hepatic complications. Hepatogastroenterology. 2007;54:839–43.
- Nagino M, Kamiya J, Arai T, Nishio H, Ebata T, Nimura Y. One hundred consecutive hepatobiliary resections for biliary hilar malignancy: preoperative blood donation, blood loss, transfusion, and outcome. Surgery. 2005;137:148–55. CrossRef
- Helling TS, Khandelwal A. The challenges of resident training in complex hepatic, pancreatic, and biliary procedures. J Gastrointest Surg. 2008;12:153–8. CrossRef
- Nanashima A, Sumida Y, Abo T, Tanaka K, Takeshita H, Hidaka S, et al. Principle of perioperative management for hepatic resection and education for young surgeons. Hepatogastroenterology. 2008;55:587–91.
- Takasaki T, Kobayashi S, Suzuki S, Muto H, Marada M, Yamana Y, et al. Predetermining postoperative hepatic function for hepatectomies. Int Surg. 1980;65:309–13.
- Kubota K, Makuuchi M, Kusaka K, Kobayashi T, Miki K, Hasegawa K, et al. Measurement of liver volume and hepatic functional reserve as a guide to decision-making in resectional surgery for hepatic tumors. Hepatology. 1997;26:1176–81.
- Miyagawa S, Makuuchi M, Kawasaki S, Kakazu T. Criteria for safe hepatic resection. Am J Surg. 1995;169:589–94. CrossRef
- Arnoletti JP, Brodsky J. Reduction of transfusion requirements during major hepatic resection for metastatic disease. Surgery. 1999;125:166–71. CrossRef
- Nanashima A, Sumida Y, Oikawa M, Murakami G, Abo T, Hidaka S, et al. Vascular transection using endovascular stapling in hepatic resection. Hepatogastroenterology. 2009;56:498–500.
- Nanashima A, Tobinaga S, Abo T, Nonaka T, Sawai T, Nagayasu T. Usefulness of the combination procedure of crash clamping and vessel sealing for hepatic resection. J Surg Oncol. 2010;102:179–83. CrossRef
- Smyrniotis V, Farantos C, Kostopanagiotou G, Arkadopoulos N. Vascular control during hepatectomy: review of methods and results. World J Surg. 2005;29:1384–96. CrossRef
- Nanashima A, Tobinaga S, Abo T, Nonaka T, Takeshita H, Hidaka S, et al. Reducing the incidence of post-hepatectomy hepatic complications by preoperatively applying parameters predictive of liver function. J Hepatobiliary Pancreat Sci. 2010;17:871–8. CrossRef
- Nanashima A, Yamaguchi H, Tanaka K, Shibasaki S, Tsuji T, Ide N, et al. Preoperative serum hyaluronic acid level as a good predictor of posthepatectomy complications. Surg Today. 2004;34:913–9. CrossRef
- Otsubo T, Takasaki K, Yamamoto M, Katsuragawa H, Katagiri S, Yoshitoshi K, et al. Bleeding during hepatectomy can be reduced by clamping the inferior vena cava below the liver. Surgery. 2004;135:67–73. CrossRef
- Takayama T, Makuuchi M, Kubota K, Harihara Y, Hui AM, Sano K, et al. Randomized comparison of ultrasonic vs. clamp transection of the liver. Arch Surg. 2001;136:922–8. CrossRef
- Ogata S, Belghiti J, Varma D, Sommacale D, Maeda A, Dondero F, et al. Two hundred liver hanging maneuvers for major hepatectomy: a single-center experience. Ann Surg. 2007;245:31–5. CrossRef
- Kokudo N, Imamura H, Sano K, Zhang K, Hasegawa K, Sugawara Y, et al. Ultrasonically assisted retrohepatic dissection for a liver hanging maneuver. Ann Surg. 2005;242:651–4. CrossRef
- Rahbari NN, Koch M, Zimmermann JB, Elbers H, Bruckner T, Contin P, et al. Infrahepatic Inferior vena cava clamping for reduction of central venous pressure and blood loss during hepatic resection: a Randomized Controlled Trial. Ann Surg. 2011;253:1102–10. CrossRef
- Soonawalla ZF, Stratopoulos C, Stoneham M, Wilkinson D, Britton BJ, Friend PJ. Role of the reverse-Trendelenberg patient position in maintaining low-CVP anaesthesia during liver resections. Langenbecks Arch Surg. 2008;393:195–8. CrossRef
- Kaibori M, Saito T, Matsui K, Yamaoka M, Kamiyama Y. Impact of fresh frozen plasma on hepatectomy for hepatocellular carcinoma. Anticancer Res. 2008;28:1749–55.
- Heiss MM, Mempel W, Delanoff C, Jauch KW, Gabka C, Mempel M, et al. Blood transfusion-modulated tumor recurrence: first results of a randomized study of autologous versus allogeneic blood transfusion in colorectal cancer surgery. J Clin Oncol. 1994;12:1859–67.
- Yokoyama Y, Nagino M, Nimura Y. Which gender is better positioned in the process of liver surgery? Male or female? Surg Today. 2007;37:823–30. CrossRef
- Wu CC, Kang SM, Ho WM, Tang JS, Yeh DC, Liu TJ, et al. Prediction and limitation of hepatic tumor resection without blood transfusion in cirrhotic patients. Arch Surg. 1998;133:1007–10. CrossRef
- Das BC, Isaji S, Kawarada Y. Analysis of 100 consecutive hepatectomies: risk factors in patients with liver cirrhosis or obstructive jaundice. World J Surg. 2001;25:266–72. CrossRef
- Yoshidome H, Miyazaki M, Shimizu H, Ito H, Nakagawa K, Ambiru S, et al. Obstructive jaundice impairs hepatic sinusoidal endothelial cell function and renders liver susceptible to hepatic ischemia/reperfusion. J Hepatol. 2000;33:59–67. CrossRef
- Matsumata T, Itasaka H, Shirabe K, Shimada M, Yanaga K, Sugimachi K. Strategies for reducing blood transfusions in hepatic resection. HPB Surg. 1994;8:1–6. CrossRef
- Nanashima A, Yamaguchi H, Shibasaki S, Morino S, Ide N, Takeshita H, et al. Relationship between indocyanine green test and technetium-99 m galactosyl serum albumin scintigraphy in patients scheduled for hepatectomy: clinical evaluation and patient outcome. Hepatol Res. 2004;28:184–90. CrossRef
- Ikeda T, Yonemura Y, Ueda N, Kabashima A, Shirabe K, Taketomi A, et al. Pure laparoscopic right hepatectomy in the semi-prone position using the intrahepatic Glissonian approach and a modified hanging maneuver to minimize intraoperative bleeding. Surg Today. 2011;41:1592–8. CrossRef
- Poon RT. Current techniques of liver transection. HPB. 2007;9:166–73. CrossRef
- Chimutengwende-Gordon M, Khan WS, Maruthainar N. Perioperative blood transfusion: the role of allogenous and autologous transfusions, and pharmacological agents. J Perioper Pract. 2010;20:283–7.
- Cho CS, Gonen M, Shia J, Kattan MW, Klimstra DS, Jarnagin WR, et al. A novel prognostic nomogram is more accurate than conventional staging systems for predicting survival after resection of hepatocellular carcinoma. J Am Coll Surg. 2008;206:281–91. CrossRef
- Predictors of intraoperative blood loss in patients undergoing hepatectomy
Volume 43, Issue 5 , pp 485-493
- Cover Date
- Print ISSN
- Online ISSN
- Springer Japan
- Additional Links
- Intraoperative blood loss
- Predictive parameters
- Postoperative outcomes
- Industry Sectors
- Author Affiliations
- 1. Division of Surgical Oncology and Department of Surgery, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, 8528501, Japan