Skip to main content

Safety and efficacy of early postoperative hyperbaric oxygen therapy with restriction of transfusions in patients with HCC who have undergone partial hepatectomy

Langenbeck's Archives of Surgery volume 396, pages 99–106 (2011)Cite this article

Abstract

Background

Recent studies have shown that intraoperative blood loss and blood transfusions promote postoperative recurrence of hepatocellular carcinoma (HCC). Hyperbaric oxygen therapy (HBOT) is a specific method of oxygen administration, which is independent of fluid therapy or blood transfusion. The aim of the present study was to assess the usefulness of acute HBOT after liver resection for patients with HCC in order to minimize the requirement for perioperative blood transfusions.

Patients and methods

Forty-one consecutive patients who showed Hb level < 9.0 mg/dl at the end of hepatic resection were randomly assigned to a control group (n = 21) or an HBOT group (n = 20). HBOT at 2.0 atm. with inhalation of 100% oxygen for a duration of 60 min was performed at 3, 24, and/or 48 h after the end of the hepatectomy. Regarding postoperative hepatic hemodynamics, liver function tests, and outcome data, prospective comparisons were completed in both groups. The two groups of patients were similar with respect to results from preoperative assessments.

Results

In six patients from the HBOT group, who experienced intraoperative major bleeding or showed fatal hepatic hypoxia (ShvO2 < 50%), the levels of ShvO2 and serum lactate were significantly improved after HBOT. When compared to the control group, the HBOT group showed better changes of ShvO2, serum lactate, and bilirubin levels for the first 3 postoperative days following surgery. Additionally, the HBOT group did not experience any fatal complications and had a lower incidence of postoperative hyperbilirubinemia than the control group. We also observed that postoperative NK cell activity and cancer-free survival in the HBOT group tended to be better than in the control group, although the differences did not reach significance.

Conclusion

These results suggest that acute HBOT after hepatectomy, aimed at reducing perioperative erythrocyte transfusions, may be employed for overcoming deficiencies in systemic and hepatic oxygen supply and thus diminishing postoperative complications. As an added benefit, such therapy may affect postoperative immunological responses and long-term survival after liver resection in HCC patients. Further analyses of the use of HBOT is warranted to confirm surgical outcome data and to assess the economic impact on healthcare costs.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

References

  1. Yamamoto J, Kosuge T, Takayama T, Shimada K, Yamasaki S, Ozaki H et al (1994) Perioperative blood transfusion promotes recurrence of hepatocellular carcinoma after hepatectomy. Surgery 115:303–309

    CAS  PubMed  Google Scholar 

  2. Johnson LB, Plotkin JS, Kuo PC (1998) Reduced transfusion requirements during major hepatic resection with use of intraoperative isovolemic hemodilution. Am J Surg 176:608–611

    CAS  Article  PubMed  Google Scholar 

  3. Asahara T, Katayama K, Itamoto T, Yano M, Hino H, Okamoto Y et al (1999) Perioperative blood transfusion as a prognostic indicator in patients with hepatocellular carcinoma. World J Surg 23:676–680

    CAS  Article  PubMed  Google Scholar 

  4. Ueno S, Tanabe G, Yoshida A, Yoshidome S, Takao S, Aikou T (1999) Postoperativeprediction of and strategy for metastatic recurrent hepatocellular carcinoma according to histologic activity of hepatitis. Cancer 86:248–254

    CAS  Article  PubMed  Google Scholar 

  5. Makino Y, Yamanoi A, Kimoto T, El-Assal ON, Kohno H, Nagasue N (2000) The influence of perioperative blood transfusion on intrahepatic recurrence after curative resection of hepatocellular carcinoma. Am J Gastroenterol 95:1294–1300

    CAS  Article  PubMed  Google Scholar 

  6. Poon RT, Fan ST, Wong J (2000) Risk factors, prevention, and management of postoperative recurrence after resection of hepatocellular carcinoma. Ann Surg 232:10–24

    Article  Google Scholar 

  7. Wu CC, Cheng SB, Ho WM, Chen JT, Liu TJ, FK PuCC (2005) Liver resection for Hepatocellular Carcinoma in patients with cirrhosis. Br J Surg 92:348–355

    Article  PubMed  Google Scholar 

  8. de Boer MT, Molenaar IQ, Porte RJ (2007) Impact of blood loss on outcome after liver resection. Dig Surg 24:259–264

    Article  PubMed  Google Scholar 

  9. Wang CC, Lyer SG, Low JK, Lin CY, Wang SH, Lu SN et al (2009) Preoperative factors affecting long-term outcomes of 473 consecutive patients undergoing hepatectomy for hepatocellular carcinoma. Ann Surg Oncol 16:1832–1842

    Article  PubMed  Google Scholar 

  10. Taketomi A, Toshima T, Kitagawa D, Motomura T, Takeishi K, Mano Y et al (2010) Predictors of extrahepatic recurrence after curative hepatectomy for hepatocellular carcinoma. Ann Surg Oncol: Epub ahead of print

  11. Makuuchi M, Takayama T, Gunven P, Kosuge T, Yamazaki S, Hasegawa H (1989) Restrictive versus liberal blood transfusion policy for hepatectomies in cirrhotic patients. World J Surg 13:644–648

    CAS  Article  PubMed  Google Scholar 

  12. Itamoto T, Katayama K, Nakahara H, Tashiro H, Asahara T (2003) Autologous blood storage before hepatectomy for hepatocellular carcinoma with underlying liver disease. Br J Surg 90:23–28

    CAS  Article  PubMed  Google Scholar 

  13. Poon RT, Fan ST, Lo CM, Ng IO, Liu CL, Lam CM et al (2001) Improving survival results after resection of hepatocellular carcinoma: a prospective study of 377 patients over 10 years. Ann Surg 234:63–70

    CAS  Article  PubMed  Google Scholar 

  14. Nonami T, Asahi K, Harada A, Nakao A, Takagi H (1991) Effect of hyperdynamic circulatory support on hepatic hemodynamics, oxygen supply and demand after massive hepatectomy. Surgery 109:277–283

    CAS  PubMed  Google Scholar 

  15. Ueno S, Tanabe G, Yamada H, Kusano C, Yoshidome S, Nuruki K et al (1998) Response of patients with cirrhosis who have undergone partial hepatectomy to treatment aimed at achieving supranormal oxygen delivery and consumption. Surgery 123:278–286

    CAS  PubMed  Google Scholar 

  16. Kawamura M, Sakakibara K, Yusa T (1978) Effect of increased oxygen on peripheral circulation in acute, temporary limb hypoxia. J Cardiovasc Surg 19:161–168

    CAS  Google Scholar 

  17. Chuba PJ, Aronin P, Bhambhani K, Eichenhorn M, Zamarano L, Cianci P et al (1997) Hyperbaric oxygen therapy for radiation-induced brain injury in children. Cancer 15:2005–2012

    Article  Google Scholar 

  18. Roeckl-Wiedmann I, BennettM KP (2005) Systematic review of hyperbaric oxygen in the management of chronic wounds. Br J Surg 92:24–32

    CAS  Article  PubMed  Google Scholar 

  19. Weiland DE (2007) Fasciotomy closure using simultaneous vacuum-assisted closure and hyperbaric oxygen. Am Surg 73:261–266

    PubMed  Google Scholar 

  20. Ueno S, Tanabe G, Kihara K, Aoki D, Arikawa K, Dogomori H et al (1999) Early postoperative hyperbaric oxygen therapy modifies neutrophil activation. Hepatogastroenterology 46:1798–1799

    CAS  PubMed  Google Scholar 

  21. Kihara K, Ueno S, Sakoda M, Aikou T (2005) Effects of hyperbaric oxygen exposure on experimental hepatic ischemia reperfusion injury: relationship between its timing and neutrophil sequestration. Liver Transpl 11:1574–1580

    Article  PubMed  Google Scholar 

  22. Sakoda M, Ueno S, Kihara K, Aikou T (2004) A potential role of hyperbaric oxygen exposure through intestinal nuclear factor-kappa B. Crit Care Med 32:1722–1729

    CAS  Article  PubMed  Google Scholar 

  23. Kainuma M, Nakashima K, Sakuma I (1992) Hepatic venous hemoglobin oxygen saturation predicts liver dysfunction after hepatectomy. Anesthesiology 76:379–386

    CAS  Article  PubMed  Google Scholar 

  24. Brittenden J, Heys SD, Ross J, Eremin O (1996) Natural killer cells and cancer. Cancer 77:1226–1243

    CAS  Article  PubMed  Google Scholar 

  25. Yoshioka S, Miyazaki M, Shimizu H, Ito H, Nakagawa K, Ambiru S et al (1998) Hepatic venous hemoglobin oxygen saturation predicts regenerative status of remnant liver after partial hepatectomy in rats. Hepatology 27:1349–1353

    CAS  Article  PubMed  Google Scholar 

  26. Vlahakes GJ (2001) Haemoglobin solutions in surgery. Br J Surg 88:1553–1555

    CAS  Article  PubMed  Google Scholar 

  27. Tanabe G, Kawaida K, Hamanoue M, Kihara K, Hirata S, Maemura M et al (1999) Treatment for accidental occlusion of the hepatic artery after hepatic resection: report of two cases. Surg Today 29:268–272

    CAS  Article  PubMed  Google Scholar 

  28. Schwesinger WH, Kurtin WE (1983) Changes in serum and bile bilirubin induced by acute hemolysis. J Surg Res 35:520–530

    CAS  Article  PubMed  Google Scholar 

  29. Torzilli G, Gambetti A, Del Fabbro D, Leoni P, Olivari N, Donadon M et al (2004) Techniques for hepatectomies without blood transfusion, focusing on interpretation of postoperative anemia. Arch Surg 139:1061–1065

    Article  PubMed  Google Scholar 

  30. Fan ST, Lo CM, Liu CL, Lam CM, Yuen WK, Yeung C et al (1999) Hepatectomy for hepatocellular carcinoma: toward zero hospital deaths. Ann Surg 229:322–330

    CAS  Article  PubMed  Google Scholar 

  31. Belghiti J, Noun R, Malafosse R, Jagot P, Sauvanet A, Pierangeli F et al (1999) Continuous versus intermittent portal triad clamping for liver resection. Ann Surg 229:369–375

    CAS  Article  PubMed  Google Scholar 

  32. Lasek W, Plodziszewska M, Jakobisiak M (1987) The effect of blood donation on natural killer activity in man. J Clin Lab Immunol 22:165–168

    CAS  PubMed  Google Scholar 

  33. Tartter PI, Burrows L, Papatestas AE, Lesnick G, Aufses AH Jr (1985) Perioperative blood transfusion has prognostic significance for breast cancer. Surgery 97:225–230

    CAS  PubMed  Google Scholar 

  34. Van Lawick van Pabst WP, Langenhorst BL, Mulder PG, Marquet RL, Jeekel J (1988) Effect of perioperative blood loss and perioperative blood transfusion on colorectal cancer survival. Eur J Cancer Clin Oncol 24:741–747

    Article  PubMed  Google Scholar 

  35. Tartter PI, Martinelli G (1987) Lymphocyte subsets, natural killer cytotoxicity, and perioperative blood transfusion for elective colorectal cancer surgery. Cancer Detect Prev Suppl 1:571–576

    CAS  PubMed  Google Scholar 

  36. Matsumata T, Ikeda Y, Hayashi H, Kamakura T, Taketomi A, Sugimachi K (1993) The association between transfusion and cancer-free survival after curative resection for hepatocellular carcinonoma. Cancer 72:1866–1871

    CAS  Article  PubMed  Google Scholar 

  37. Kwon AH, Matsui Y, Kamiyama Y (2001) Perioperative blood transfusion in hepatocellular carcinoma. Cancer 91:771–778

    CAS  Article  PubMed  Google Scholar 

Download references

Conflicts of interest

None.

Author information

Affiliations

  1. Department of Surgical Oncology and Digestive Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, Japan

    Shinichi Ueno, Masahiko Sakoda, Hiroshi Kurahara, Satoshi Iino, Koji Minami, Kei Ando, Yukou Mataki, Kosei Maemura, Sumiya Ishigami & Shoji Natsugoe

  2. School of Health Sciences, Faculty of Medicine, Kagoshima University, Kagoshima, Japan

    Hiroyuki Shinchi

Authors
  1. Shinichi Ueno
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Masahiko Sakoda
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hiroshi Kurahara
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Satoshi Iino
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Koji Minami
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kei Ando
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yukou Mataki
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Kosei Maemura
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Sumiya Ishigami
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Hiroyuki Shinchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Shoji Natsugoe
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shinichi Ueno.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Ueno, S., Sakoda, M., Kurahara, H. et al. Safety and efficacy of early postoperative hyperbaric oxygen therapy with restriction of transfusions in patients with HCC who have undergone partial hepatectomy. Langenbecks Arch Surg 396, 99–106 (2011). https://doi.org/10.1007/s00423-010-0725-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00423-010-0725-z

Keywords

  • Hepatocellular carcinoma
  • Blood transfusion
  • Hyperbaric oxygen therapy
  • Hepatectomy
  • Hepatic venous oxygen saturation