title: Intra-operative blood loss predicts complications after a second hepatectomy for malignant neoplasms.
abstract: OBJECTIVE
  We investigated the risk of morbidity after repeat resections for liver recurrence of hepatocellular carcinoma or for colorectal liver metastases.
  
  
  BACKGROUND
  Although repeat hepatectomy for recurrences of hepatocellular carcinoma or for colorectal cancer liver metastases is well known only to carry risks similar to those seen for an initial liver resection, the safety of such a procedure is questionable because, typically, only a few liver tumors are thought suitable for repeat hepatectomy.
  
  
  METHODS
  Clinicopathology data were available for 412 hepatectomy patients (hepatocellular carcinoma in 226, colorectal liver metastases in 186). Risk factors for postoperative complications were analyzed retrospectively among the 57 patients undergoing a repeat hepatectomy.
  
  
  RESULTS
  Using multivariate analysis, intraoperative blood loss (relative risk, 9.61; P = 0.02) affected the occurrence of postoperative complications after a second hepatectomy. In patients who lost more than 1.29 l blood intraoperatively at the second hepatectomy, a major hepatectomy (P < 0.05) by means of an anatomical type of resection (P < 0.01) was more often performed than in the patients with 1.29 l or less of blood loss.
  
  
  CONCLUSIONS
  The major independent risk factor associated with complications after a second hepatectomy for liver recurrence was intraoperative blood loss. The extent of liver resection, especially in an anatomical manner, directly influences the amount of blood loss.
authors.affiliation: Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan. ktrj112@urahp.yokohama-cu.ac.jp
authors.forename: Kuniya
authors.initials: K
authors.lastname: Tanaka
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Shimada
authors.forename: Kenichi
authors.initials: K
authors.lastname: Matsuo
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Nagano
authors.forename: Itaru
authors.initials: I
authors.lastname: Endo
authors.forename: Shinji
authors.initials: S
authors.lastname: Togo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery*; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local; D011183:Postoperative Complications; D016016:Proportional Hazards Models; D012372:ROC Curve; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D018709:Statistics, Nonparametric