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Relationship between hepatic venous anatomy and hepatic venous blood loss during hepatectomy

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Abstract

Purpose

Predicting increased blood loss based on anatomical intervascular relationships is essential in major hepatectomy.

Methods

We assessed 63 consecutive patients undergoing anatomical hepatectomy exposing the hepatic vein (HV) trunk at two institutes. Correlations between anatomical alterations of the hepatic inferior vena cava (IVC), HV, hepatic IVC, or right atrium (RA) and the blood loss per standard weight (BLSW) or blood transfusion (n = 18) were analyzed. The results of IVC partial clamping (PC) were additionally examined.

Results

The BLSW in type V-up anatomical morphology was significantly higher than that in straight type (p < 0.05). The parameters associated with an increased BLSW (> 13.5 mL/kg) were tumor size (> 4 cm), prothrombin activity (< 87%), CVP (> 7 mmHg), area of suprahepatic IVC (< 360 mm2), IVC-RA gap (> 28 mm), longitudinal angle of IVC (< 160°), and axial angle of the MHV (< 55°). A multivariate analysis revealed that a high IVC-RA gap was a significant independent risk factor (odds ratio; 4.32, p < 0.05). Among 25 patients undergoing IVC-PC, only three showed a remarkable decrease in hepatic venous bleeding. No other statistically significant differences in the surgical records were observed in most cases.

Conclusion

The IVC-RA gap might be a promising novel predictive parameter reflecting increased blood loss leading to blood transfusion in anatomical hepatectomy.

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Acknowledgements

The principal author sincerely appreciates Professor Naoaki Ichihara for giving instructions regarding statistical limitations during the revision process.

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Authors and Affiliations

  1. Division of Hepatobiliary Pancreas Surgery, Department of Surgery, University of Miyazaki Faculty of Medicine, Kiyotake 5200, Miyazaki, 889-1692, Japan

    Atsushi Nanashima, Yukinori Tanoue, Masahide Hiyoshi, Naoya Imamura, Takeomi Hamada, Koichi Yano, Takahiro Nishida, Mitsutoshi Ishii & Kunihide Nakamura

  2. Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto, Nagasaki, Japan

    Atsushi Nanashima, Yukinori Tanoue, Mitsutoshi Ishii & Takeshi Nagayasu

  3. Department of Radiology, University of Miyazaki Faculty of Medicine, Kiyotake 5200, Miyazaki, Japan

    Tatefumi Sakae

  4. Department of Anesthesiology, University of Miyazaki Faculty of Medicine, Kiyotake 5200, Miyazaki, Japan

    Isao Tsuneyoshi

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  1. Atsushi Nanashima
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Correspondence to Atsushi Nanashima.

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Nanashima, A., Tanoue, Y., Sakae, T. et al. Relationship between hepatic venous anatomy and hepatic venous blood loss during hepatectomy. Surg Today 51, 1953–1968 (2021). https://doi.org/10.1007/s00595-021-02314-5

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