title: Amount of operative blood loss affects the long-term outcome after liver resection for hepatocellular carcinoma.
abstract: OBJECTIVE
  Numerous prognostic factors for HCC have been reported. Few literatures have reported clinical significance of amount of intraoperative blood loss (ABL) for the outcome after surgery for HCC. The aim of this study is to analyze the significance of ABL for outcome after surgery for HCC.
  
  
  METHODS
  A total of 301 patients who underwent liver resection for HCC between January 1998 and June 2007 were included. Clinical and surgical characteristics were collected and prognostic factors were identified using univariate and multivariate analysis.
  
  
  RESULTS
  Impaired liver function (liver damage B), large tumor (>36mm), multiple tumors, existence of macroscopic vessel invasion, large ABL (=700mL) and replacement of red blood cells were identified as independent prognostic factors for overall survival (OS). For disease free survival (DFS), old age (>66), male gender, impaired liver function, large tumor, multiple tumors, existence of macroscopic vessel invasion and large ABL were extracted. Limited to the patients without blood transfusion, large ABL is associated with poor OS and DFS.
  
  
  CONCLUSIONS
  Large ABL could result in poor OS and DFS after liver resection of HCC in patients without blood transfusion. Surgeons have to make the best effort to reduce ABL.
authors.affiliation: Department of Gastroenterological Surgery, Kumamoto University, Kumamoto, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Chikamoto
authors.forename: Toru
authors.initials: T
authors.lastname: Beppu
authors.forename: Toshiro
authors.initials: T
authors.lastname: Masuda
authors.forename: Ryu
authors.initials: R
authors.lastname: Otao
authors.forename: Hirohisa
authors.initials: H
authors.lastname: Okabe
authors.forename: Hiromitsu
authors.initials: H
authors.lastname: Hayashi
authors.forename: Shinichi
authors.initials: S
authors.lastname: Sugiyama
authors.forename: Masayuki
authors.initials: M
authors.lastname: Watanabe
authors.forename: Takatoshi
authors.initials: T
authors.lastname: Ishiko
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Takamori
authors.forename: Hideo
authors.initials: H
authors.lastname: Baba
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical / Q000401:mortality* / Q000517:prevention & control; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models