title: Decreased blood loss reduces postoperative complications in resection for hepatocellular carcinoma.
abstract: BACKGROUND
  The correlation between blood loss and the risk of postoperative complications was unclear in patients undergoing resection of hepatocellular carcinoma (HCC).
  
  
  METHODS
  We studied 539 patients who had resection of HCC. Postoperative complications were recorded according to the modified Clavien-Dindo classification. Variables were compared between patients with grade III to V complications and those with no or grade I to II. A spline regression analysis was used to estimate the probability of grade III to V complications.
  
  
  RESULTS
  Among variables, blood loss (P = 0.0001), operating time (P = 0.0001), blood transfusion (P = 0.0001), and tumor size (P = 0.02) differed significantly between patients with grade III to V and those with no or I to II. Multivariate analysis revealed that the factor most strongly related to complications was blood loss (odds ratio 1.68; 95% confidence interval [CI] 1.45-1.96, P = 0.0001). Spline regression analysis showed that an increase in blood loss was accompanied by increase in the risk of complication; when the estimated probability of grade III to V complications exceeded 50% (95% CI 30.0-70.0), the corresponding blood loss was 820 ml.
  
  
  CONCLUSIONS
  Decrease in blood loss in resection of HCC is accompanied by reduced risk of complications. Surgeons need to minimize blood loss as less as 820 ml.
authors.affiliation: Department of Digestive Surgery, Nihon University School of Medicine, 30-1 Ohyaguchikami-machi, Itabashi-ku, Tokyo, 173-8610, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Aramaki
authors.forename: Tadatoshi
authors.initials: T
authors.lastname: Takayama
authors.forename: Tokio
authors.initials: T
authors.lastname: Higaki
authors.forename: Hisashi
authors.initials: H
authors.lastname: Nakayama
authors.forename: Takao
authors.initials: T
authors.lastname: Ohkubo
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Midorikawa
authors.forename: Masamichi
authors.initials: M
authors.lastname: Moriguchi
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Matsuyama
mesh_terms: 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; D015999:Multivariate Analysis; D011182:Postoperative Care; D011183:Postoperative Complications / Q000517:prevention & control*; D012044:Regression Analysis
keywords: Blood loss; Clavien-Dindo classification; Hepatocellular carcinoma; Liver resection; Operative morbidity