Impact of Blood Loss on Outcome after Liver Resection

Abstract

Partial liver resections are the treatment of choice for patients with a malignant liver or bile duct tumor. The most frequent indications for partial liver resections are colorectal metastasis, hepatocellular carcinoma (HCC) and cholangiocarcinoma. Liver resection is the only therapy with a chance for cure in these patients. Refinements in surgical technique and increasing experience have contributed to a reduction in perioperative morbidity and mortality in recent years. Despite these improvements, partial liver resections remain a major surgical procedure and carry the risk for excessive blood loss and a subsequent need for blood transfusion. Blood transfusions have been associated with systemic side effects, such as depression of the immune system. Several studies have suggested that perioperative blood loss or transfusions have a negative impact on postoperative outcome. However, it has been debated whether this is due to a real cause-effect relationship or merely the result of more complicated surgery. We have reviewed the literature concerning studies focusing on the relationship between blood loss and blood transfusion during liver surgery for malignant tumors and postoperative outcome. Most studies were based on a retrospective analysis of single center experiences, using uni- and multivariate statistical methods. Most studies have demonstrated a significant and clinically relevant association between blood transfusion and postoperative mortality and morbidity, especially postoperative infectious complications. The effect of blood transfusions on tumor recurrence and more long-term mortality is much less clear and evidence varies depending on the type of malignancy. The strongest indication that blood transfusion may have an impact on tumor recurrence has been found for patients with early stages of HCC. However, overall, no such effect could be demonstrated for patients undergoing partial liver resection for late stages of HCC, colorectal liver metastasis or cholangiocarcinoma.

Hemostatic Efficacy and Safety of the Novel Medical Adhesive, MAR VIVO-107, in a Rabbit Liver Resection Model

“…Besides, even in recent years, operative intervention to manage liver trauma is needed in about 14% of patients, including those who initially present with hemodynamic instability or those who fail nonoperative management [20]. Despite the improvements in surgical techniques and patient care, blood loss is still a main cause of perioperative morbidity and mortality in both elective liver resections and hepatic trauma surgery [1, 2]. When conventional techniques are ineffective or impractical to manage hepatic bleeding, topical hemostatic agents offer a helpful option for surgeons [6].…”

“…Hepatic hemorrhage that occurs during surgery or as a result of blunt injury or penetrating trauma results in increased morbidity and mortality [1, 2]. The liver tissue is a fragile structure with a rich blood supply provided by the hepatic artery and portal vein.…”

Colorectalis rák májáttéteinek sebészi kezelése szinkron májreszekcióval

“…Nagy beteganyagon gyűjtött adatok alapján a colorectalis rák májátt étei miatt végzett májreszekciók mortalitása alacsony, mindössze 4,3% (6,20). A legtöbb nemzetközi tanulmány összefüggést lát májreszekció esetén a perioperatíven transzfundált vérmennyiség, a mortalitás és a morbiditás között , bár az emelkedett mortalitás többek szerint a komplikáltabb műtét következménye (7,20). Az agresszív sebészi szemlélet javítja az IV.…”

Perioperative blood transfusion as a poor prognostic factor after aggressive surgical resection for hilar cholangiocarcinoma

“…6,7,16,17,19 However, aggressive and complex procedures such as hepatectomy with en bloc resection of the caudate lobe and extrahepatic bile duct for HCCA cause excessive intraoperative loss of blood that requires perioperative blood transfusion, which may also result in negative outcomes for malignant tumors of the liver. 20 However, the effects of blood transfusion on survival after aggressive surgery for HCCA have not been widely studied.…”