Risk Factors for Massive Bleeding During Major Hepatectomy

Overview

Journal World J Surg

Publisher Wiley

Specialty General Surgery

Date 2010 Feb 26

PMID 20182718

Citations 13

Authors

Ken Shirabe

Kiyoshi Kajiyama

Norifumi Harimoto

Eiji Tsujita

Shigeki Wakiyama

Yoshihiko Maehara

Affiliations

Soon will be listed here.

Abstract

Background: Massive bleeding during hepatectomy is a risk for mortality and morbidity. We examined the risk factors for massive bleeding and their correlations with outcomes.

Methods: The study was a retrospective case series. Among 353 consecutively hepatectomized patients, the mean estimated blood loss (EBL) was 825 ml. Ten patients (2.8%) experienced EBL of between 3000 and 5000 ml. Five patients (1.4%) experienced massive EBL defined as more than 5000 ml, and all five patients had undergone right major hepatectomy (RMH) for primary liver cancer (PLC). All the patients with PLC who underwent RMH were divided into two groups: group I with EBL < or = 5000 ml (n = 19) and group II with EBL > 5000 ml (n = 5). Perioperative factors regarding massive bleeding and operative mortality and morbidity were compared between the two groups.

Results: Among the ten patients who experienced EBL of between 3000 and 5000 ml, three had partial hepatectomy of no more than subsegmentectomy of the paracaval portion of the caudate lobe and three had central bisegmentectomy. The mean tumor size was 7.9 +/- 4.7 cm in group I and 15.1 +/- 2.2 cm in group II (P = 0 .0034). Tumor compression of the inferior vena cava (IVC) on CT scans was observed in all patients in group II, but in no patients in group I (P < 0.0001). Four of five patients in group II received surgery through an anterior approach. The liver-hanging maneuver (LHM) was applied in 14 of 19 patients (74%) in group I but could not be applied in group II (P = 0.0059). No postoperative and in-hospital mortalities occurred in group II and there were no significant differences in the incidence of mortality and morbidity between the groups.

Conclusions: RMH for large PLCs, tumor compression of the IVC, and an anterior approach without the LHM are risks for massive bleeding during hepatectomy. Preparation of rapid infusion devices in these cases is necessary to avoid prolonged hypotension.

Citing Articles

Risk Factors of Complications from Central Bisectionectomy (H458) for Hepatocellular Carcinoma: A Multi-Institutional Single-Arm Analysis.

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Premature Macrophage Activation by Stored Red Blood Cell Transfusion Halts Liver Regeneration Post-Partial Hepatectomy in Rats.

Abudi N, Duev O, Asraf T, Blank S, Matot I, Abramovitch R Cells. 2022; 11(21).

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The Association between Prognostic Nutritional Index (PNI) and Intraoperative Transfusion in Patients Undergoing Hepatectomy for Hepatocellular Carcinoma: A Retrospective Cohort Study.

Sim J, Kim S, Jun I, Kang S, Kim B, Kim S Cancers (Basel). 2021; 13(11).

PMID: 34063772 PMC: 8196581. DOI: 10.3390/cancers13112508.

Association of intraoperative hypotension with acute kidney injury after liver resection surgery: an observational cohort study.

Liao P, Zhao S, Lyu L, Yi X, Ji X, Sun J BMC Nephrol. 2020; 21(1):456.

PMID: 33138788 PMC: 7607844. DOI: 10.1186/s12882-020-02109-9.

The effect of low central venous pressure on hepatic surgical field bleeding and serum lactate in patients undergoing partial hepatectomy: a prospective randomized controlled trial.

Yu L, Sun H, Jin H, Tan H BMC Surg. 2020; 20(1):25.

PMID: 32019557 PMC: 7001244. DOI: 10.1186/s12893-020-0689-z.

References

Otsubo T, Takasaki K, Yamamoto M, Katsuragawa H, Katagiri S, Yoshitoshi K . Bleeding during hepatectomy can be reduced by clamping the inferior vena cava below the liver. Surgery. 2003; 135(1):67-73. DOI: 10.1016/s0039-6060(03)00343-x. View

Bedossa P, Poynard T . An algorithm for the grading of activity in chronic hepatitis C. The METAVIR Cooperative Study Group. Hepatology. 1996; 24(2):289-93. DOI: 10.1002/hep.510240201. View

Shirabe K, Shimada M, Gion T, Hasegawa H, Takenaka K, Utsunomiya T . Postoperative liver failure after major hepatic resection for hepatocellular carcinoma in the modern era with special reference to remnant liver volume. J Am Coll Surg. 1999; 188(3):304-9. DOI: 10.1016/s1072-7515(98)00301-9. View

Sitzmann J, Greene P . Perioperative predictors of morbidity following hepatic resection for neoplasm. A multivariate analysis of a single surgeon experience with 105 patients. Ann Surg. 1994; 219(1):13-7. PMC: 1243084. DOI: 10.1097/00000658-199401000-00003. View

. Intraobserver and interobserver variations in liver biopsy interpretation in patients with chronic hepatitis C. The French METAVIR Cooperative Study Group. Hepatology. 1994; 20(1):15-20. View

Azoulay D, Castaing D, Adam R, Savier E, Bismuth H . The anterior approach: the right way for right massive hepatectomy. J Am Coll Surg. 2001; 192(3):412-7. DOI: 10.1016/s1072-7515(01)00781-5. View

Lai E, Fan S, Lo C, Chu K, Liu C . Anterior approach for difficult major right hepatectomy. World J Surg. 1996; 20(3):314-7; discussion 318. DOI: 10.1007/s002689900050. View

Batignani G, Zuckermann M . Inferior approach for the isolation of the left-middle hepatic veins in liver resections: a safe way. Arch Surg. 2005; 140(10):968-71. DOI: 10.1001/archsurg.140.10.968. View

Rahbari N, Koch M, Mehrabi A, Weidmann K, Motschall E, Kahlert C . Portal triad clamping versus vascular exclusion for vascular control during hepatic resection: a systematic review and meta-analysis. J Gastrointest Surg. 2008; 13(3):558-68. DOI: 10.1007/s11605-008-0588-6. View

10.

Helling T, Blondeau B, Wittek B . Perioperative factors and outcome associated with massive blood loss during major liver resections. HPB (Oxford). 2008; 6(3):181-5. PMC: 2020678. DOI: 10.1080/13651820410030826. View

11.

Buell J, Koffron A, Yoshida A, Hanaway M, Lo A, Layman R . Is any method of vascular control superior in hepatic resection of metastatic cancers? Longmire clamping, pringle maneuver, and total vascular isolation. Arch Surg. 2001; 136(5):569-75. DOI: 10.1001/archsurg.136.5.569. View

12.

Kim Y, Chin J, Kang S, Jun I, Song J, Jeong S . Association between central venous pressure and blood loss during hepatic resection in 984 living donors. Acta Anaesthesiol Scand. 2009; 53(5):601-6. DOI: 10.1111/j.1399-6576.2009.01920.x. View

13.

McCormack L, Petrowsky H, Jochum W, Furrer K, Clavien P . Hepatic steatosis is a risk factor for postoperative complications after major hepatectomy: a matched case-control study. Ann Surg. 2007; 245(6):923-30. PMC: 1876953. DOI: 10.1097/01.sla.0000251747.80025.b7. View

14.

Ogata S, Belghiti J, Varma D, Sommacale D, Maeda A, Dondero F . Two hundred liver hanging maneuvers for major hepatectomy: a single-center experience. Ann Surg. 2007; 245(1):31-5. PMC: 1867932. DOI: 10.1097/01.sla.0000224725.40979.0a. View

15.

Nakajima Y, Shimamura T, Kamiyama T, Matsushita M, Sato N, Todo S . Control of intraoperative bleeding during liver resection: analysis of a questionnaire sent to 231 Japanese hospitals. Surg Today. 2002; 32(1):48-52. DOI: 10.1007/s595-002-8112-0. View

16.

Melendez J, Ferri E, Zwillman M, Fischer M, Dematteo R, Leung D . Extended hepatic resection: a 6-year retrospective study of risk factors for perioperative mortality. J Am Coll Surg. 2001; 192(1):47-53. DOI: 10.1016/s1072-7515(00)00745-6. View

17.

Katz S, Shia J, Liau K, Gonen M, Ruo L, Jarnagin W . Operative blood loss independently predicts recurrence and survival after resection of hepatocellular carcinoma. Ann Surg. 2009; 249(4):617-23. DOI: 10.1097/SLA.0b013e31819ed22f. View

18.

Nuzzo G, Giuliante F, Giovannini I, Vellone M, De Cosmo G, Capelli G . Liver resections with or without pedicle clamping. Am J Surg. 2001; 181(3):238-46. DOI: 10.1016/s0002-9610(01)00555-4. View

19.

Ekberg H, Tranberg K, Andersson R, Jeppsson B, Bengmark S . Major liver resection: perioperative course and management. Surgery. 1986; 100(1):1-8. View

20.

Takenaka K, Kawahara N, Yamamoto K, Kajiyama K, Maeda T, Itasaka H . Results of 280 liver resections for hepatocellular carcinoma. Arch Surg. 1996; 131(1):71-6. DOI: 10.1001/archsurg.1996.01430130073014. View