title: Risk factors for massive blood loss during liver resection for hepatocellular carcinoma in patients with cirrhosis.
abstract: OBJECTIVE
  Liver resection for hepatocellular carcinoma in patients with cirrhosis carries risk of major hemorrhage and sometimes requires blood transfusion. We investigated risk factors for massive blood loss during liver resection and indications for storing blood for autologous intraoperative transfusion.
  
  
  METHODS
  We analyzed clinical records of 100 patients with cirrhosis who underwent liver resection for hepatocellular carcinoma. Autologous blood was stored preoperatively for 19 patients.
  
  
  RESULTS
  Intraoperative blood loss ranged from 5 to 3000 mL (mean, 640). Liver resection was performed without transfusion in 67 patients and with autologous blood storage in 17 patients not receiving homologous blood. In the other 16 patients, homologous blood was transfused. Univariate analysis identified youth, large tumors (> 4cm), major hepatectomy, portal tumor involvement, hepatic vein involvement, and prolonged operation time as risk factors for massive blood loss; multivariate analysis identified portal involvement and hepatic vein involvement as independent risk factors. Blood loss exceeded 1000 mL in the 4 transfused group B patients and 3 of the 4 patients had hepatic vein involvement.
  
  
  CONCLUSIONS
  Portal involvement and hepatic vein involvement were risk factors for massive blood loss during liver resection for hepatocellular carcinoma in patients with cirrhosis. Autologous blood storage is indicated in patients with such risk factors.
authors.affiliation: Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka 545-8585, Japan. m7696493@msic.med.osaka-cu.ac.jp
authors.forename: Shoji
authors.initials: S
authors.lastname: Kubo
authors.forename: Shigekazu
authors.initials: S
authors.lastname: Takemura
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yamamoto
authors.forename: Seikan
authors.initials: S
authors.lastname: Hai
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Ichikawa
authors.forename: Shintaro
authors.initials: S
authors.lastname: Kodai
authors.forename: Shinkawa
authors.initials: S
authors.lastname: Hiroji
authors.forename: Taichi
authors.initials: T
authors.lastname: Shuto
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Hirohashi
authors.forename: Hiromu
authors.initials: H
authors.lastname: Tanaka
mesh_terms: D000368:Aged; D016063:Blood Loss, Surgical; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000601:surgery*; D005260:Female; D006498:Hepatectomy; D006503:Hepatic Veins / Q000473:pathology; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008113:Liver Neoplasms / Q000150:complications / Q000601:surgery*; D008297:Male; D011168:Portal System / Q000473:pathology; D012189:Retrospective Studies; D012307:Risk Factors