title: Value of live donor liver transplantation experience in major hepatectomy for hepatocellular carcinoma.
abstract: BACKGROUND
  Live donor liver transplantation (LDLT) mandates conversance in liver anatomy and major hepatectomy. Hepatocellular carcinoma is most reliably treated by hepatectomy.
  
  
  OBJECTIVE
  The outcomes of major hepatectomy for hepatocellular carcinoma are influenced by the surgeon's LDLT experience.
  
  
  METHODS
  We collected prospective cohort study data on patient and disease characteristics.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  A retrospective study was performed on 250 patients who underwent major hepatectomy for hepatocellular carcinoma from January 16, 1996, through December 28, 2001.
  
  
  METHODS
  Overall and disease-free survival and outcomes including blood loss, blood transfusion, and complications.
  
  
  RESULTS
  The 3 liver transplantation surgeons (LTSs) performed 102 major hepatectomies; the 4 hepatobiliary and pancreatic surgeons (HBPSs), 148 major hepatectomies. Patients in both groups had similar baseline characteristics. The mean +/- SD blood loss in the LTS and HBPS groups was 1.36 +/- 1.37 and 2.21 +/- 2.40 L, respectively (P<.001). The mean +/- SD blood transfusion in the LTS and HBPS groups was 0.27 +/- 0.82 and 0.51 +/- 0.94 L, respectively (P =.001). Fewer patients in the LTS group required blood transfusion (17/102 [16.7%]; HBPS group, 57/148 [38.5%]; P<.001). We found no difference in overall and disease-free survival between the groups. The median overall survival was 55.8 months for the nontransfused group, and 34.3 months for the transfused group (P =.06). Median disease-free survival was 16.1 months for the nontransfused group compared with 12.4 months for the transfused group (P =.25). Cox regression multivariate analysis showed that transfusion, cirrhosis, and venous invasion worsened overall survival. Venous invasion, cirrhosis, and tumor size adversely affected disease-free survival.
  
  
  CONCLUSIONS
  The LTS group lost less blood and required less blood transfusions than the HBPS group. Blood transfusion worsened overall survival. The significantly lower blood transfusion requirement of the LTS group contributes to a potential advantage in their overall survival.
authors.affiliation: Department of Surgery, The University of Hong Kong Medical Center, Queen Mary Hospital, Hong Kong, People's Republic of China. seechingchan@hotmail.com
authors.forename: See-Ching
authors.initials: SC
authors.lastname: Chan
authors.forename: Chi-Leung
authors.initials: CL
authors.lastname: Liu
authors.forename: Chung-Mau
authors.initials: CM
authors.lastname: Lo
authors.forename: Chi-Ming
authors.initials: CM
authors.lastname: Lam
authors.forename: Ronnie Tung-Ping
authors.initials: RT
authors.lastname: Poon
authors.forename: Wai-Key
authors.initials: WK
authors.lastname: Yuen
authors.forename: Sheung-Tat
authors.initials: ST
authors.lastname: Fan
authors.forename: John
authors.initials: J
authors.lastname: Wong
mesh_terms: D000368:Aged; D016063:Blood Loss, Surgical; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D002983:Clinical Competence; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies