title: Operative blood loss independently predicts recurrence and survival after resection of hepatocellular carcinoma.
abstract: OBJECTIVE
  To determine if the degree of blood loss during resection of hepatocellular carcinoma (HCC) is predictive of recurrence and long-term survival.
  
  
  BACKGROUND
  Several studies have addressed the impact of blood transfusion on survival and recurrence after liver resection for HCC. However, the independent effect of intraoperative estimated blood loss (EBL) on oncologic outcome is unclear.
  
  
  METHODS
  From our prospective database, we identified 192 patients who had a partial hepatectomy for HCC from 1985 to 2002. Clinicopathologic predictors of EBL were identified using logistic regression. Overall survival (OS), disease-specific survival (DSS), and recurrence free survival (RFS) were assessed using the Kaplan-Meier and Cox regression methods.
  
  
  RESULTS
  The median patient age was 64 (range, 19-86) and 66% were men. All patients had histologically proven HCC. The median follow-up time was 34 months (range, 1-297). Factors associated with increased EBL on multivariate analysis were male gender, vascular invasion, extent of hepatectomy, and operative time (P < 0.01). EBL and vascular invasion were independent predictors of OS and DSS. Only EBL was significantly associated with RFS on multivariate analysis (P = 0.02). Additionally, we found a significant inverse correlation between increasing levels of EBL and length of DSS (P = 0.01).
  
  
  CONCLUSIONS
  The magnitude of EBL during HCC resection is related to biologic characteristics of the tumor as well as the extent of surgery. Increased intraoperative blood loss during HCC resection is an independent prognostic factor for tumor recurrence and death.
authors.affiliation: Hepatopancreatobiliary Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
authors.forename: Steven C
authors.initials: SC
authors.lastname: Katz
authors.forename: Jinru
authors.initials: J
authors.lastname: Shia
authors.forename: Kui Hin
authors.initials: KH
authors.lastname: Liau
authors.forename: Mithat
authors.initials: M
authors.lastname: Gonen
authors.forename: Leyo
authors.initials: L
authors.lastname: Ruo
authors.forename: William R
authors.initials: WR
authors.lastname: Jarnagin
authors.forename: Yuman
authors.initials: Y
authors.lastname: Fong
authors.forename: Michael I
authors.initials: MI
authors.lastname: D'Angelica
authors.forename: Leslie H
authors.initials: LH
authors.lastname: Blumgart
authors.forename: Ronald P
authors.initials: RP
authors.lastname: Dematteo
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical / Q000401:mortality*; D006528:Carcinoma, Hepatocellular / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000401:mortality*; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000401:mortality; D011237:Predictive Value of Tests; D011336:Probability; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D016019:Survival Analysis; D055815:Young Adult