Risk factors associated with intra-operative major blood loss in patients with hepatocellular carcinoma who underwent hepatic resection.
BACKGROUND
Minimizing intraoperative blood loss during hepatectomy for hepatocellular carcinoma (HCC) decreases the need for blood transfusion. The purpose of this study was to investigate the risk factors associated with major blood loss in performing liver resection for HCC.


METHODS
A total of 643 consecutive patients who underwent hepatic resection for HCC were included in this retrospective study. Patients were divided into groups according to the intraoperative blood loss. Blood loss more than 1,000 mL was defined as major blood loss. Twenty-eight variables were analyzed.


RESULTS
As compared with patients with blood loss < 1,000 mL, patients with major blood loss had worse disease-free and overall survival rates (p < 0.001). Patients with major blood loss had higher surgical morbidity, mortality and prolonged hospital stay (p < 0.001). Multivariate analysis shows that independent risk factors associated with major blood loss include: male gender, alanine aminotrasferase > 55U/dL, prothrombin time < 95%, resection more than 3 Couinaud segments, en bloc resection, surgeon with low case volume (< 65 cases) and tumor with central location.


CONCLUSIONS
Hemorrhage control is the main problem in liver resection for HCC. In patients with risk factors of major bleeding, it is essential to take effective measure in order to minimize intraoperative blood loss in hepatectomy for patients with HCC.
Li
Chao-Hsu
CH
Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.
Chau
Gar-Yang
GY
Lui
Wing Yiu
WY
Tsay
Shyh-Haw
SH
King
Kuang-Liang
KL
Hsia
Cheng-Yuan
CY
Wu
Chew-Wun
CW
D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000517:prevention & control; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors