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Surgical Endoscopy

Published in:

01-11-2017

Impact of intraoperative blood loss on the short-term outcomes of laparoscopic liver resection

Authors: Rahul Gupta, David Fuks, Christophe Bourdeaux, Pejman Radkani, Takeo Nomi, Christian Lamer, Brice Gayet

Published in: Surgical Endoscopy | Issue 11/2017

Abstract

Background

Intraoperative blood loss is one of the predictors of outcome of open hepatectomy. But the impact of blood loss in laparoscopic hepatectomy (LH) on postoperative outcomes is poorly understood. The aim of this study is to analyze the association between blood loss and postoperative outcomes after LH.

Methods

A retrospective analysis of prospectively maintained database of patients undergoing LH from 1995 to 2016 was performed. The data were divided into two groups based on the extent of blood loss: Group 1 (<250 ml) and Group 2 (≥250 ml). The basic characteristics and postoperative outcomes were compared between these groups.

Results

A total of 504 patients underwent 611 LH (Group 1: 414 and Group 2: 197). The mean age was 62.4 years. The most common indication was liver secondaries (71.7%). Major hepatectomy was performed in 37% cases. Mean operative time was 225 ± 110.5 min and estimated blood loss was 239 ± 399.4 ml (range 0–4500 ml). Group 2 had significantly higher number of patients with malignant lesions undergoing major hepatectomy, anatomical resection with higher requirement for blood transfusion, and longer hospital stay. The incidence of conversion rate, overall complications including liver failure, renal failure, and postoperative mortality, was significantly higher in Group 2. However, the bile leak rate was similar in the two groups.

Conclusion

Intraoperative blood loss is most frequent in patients undergoing major LH. Blood loss ≥250 ml during LH may adversely affect the postoperative outcomes.

Fan ST, Lo CM, Liu CL, Lam CM, Yuen WK, Yeung C, Wong J (1999) Hepatectomy for hepatocellular carcinoma: toward zero hospital deaths. Ann Surg 229:322–330CrossRefPubMedPubMedCentral

Wei AC, Tung-Ping Poon R, Fan ST, Wong J (2003) Risk factors for perioperative morbidity and mortality after extended hepatectomy for hepatocellular carcinoma. Br J Surg 90:33–41CrossRefPubMed

Jarnagin WR, Gonen M, Fong Y, DeMatteo RP, Ben-Porat L, Little S, Corvera C, Weber S, Blumgart LH (2002) Improvement in perioperative outcome after hepatic resection: analysis of 1803 consecutive cases over the past decade. Ann Surg 236:397–406CrossRefPubMedPubMedCentral

Reich H, McGlynn F, DeCaprio J, Budin R (1991) Laparoscopic excision of benign liver lesions. Obstet Gynecol 78:956–958PubMed

Gagner M, Rheault M, Dubuc J (1992) Laparoscopic partial hepatectomy for liver tumor [abstract]. Surg Endosc 6:99

Ito K, Ito H, Are C, Allen PJ, Fong Y, DeMatteo RP, Jarnagin WR, D’Angelica MI (2009) Laparoscopic versus open liver resection: a matched-pair case control study. J Gastrointest Surg 13:2276–2283CrossRefPubMed

Belli G, Limongelli P, Fantini C, D’Agostino A, Cioffi L, Belli A, Russo G (2009) Laparoscopic and open treatment of hepatocellular carcinoma in patients with cirrhosis. Br J Surg 96:1041–1048CrossRefPubMed

Topal B, Fieuws S, Aerts R, Vandeweyer H, Penninckx F (2008) Laparoscopic versus open liver resection of hepatic neoplasms: comparative analysis of short-term results. Surg Endosc 22:2208–2213CrossRefPubMed

Tranchart H, Di Giuro G, Lainas P, Roudie J, Agostini H, Franco D, Dagher I (2010) Laparoscopic resection for hepatocellular carcinoma: a matched-pair comparative study. Surg Endosc 24:1170–1176CrossRefPubMed

10.

Cauchy F, Fuks D, Nomi T, Schwarz L, Barbier L, Dokmak S, Scatton O, Belghiti J, Soubrane O, Gayet B (2015) Risk factors and consequences of conversion in laparoscopic major liver resection. Br J Surg 102:785–795CrossRefPubMed

11.

Kawaguchi Y, Nomi T, Fuks D, Mal F, Kokudo N, Gayet B (2016) Hemorrhage control for laparoscopic hepatectomy: technical details and predictive factors for intraoperative blood loss. Surg Endosc 30:2543–2551CrossRefPubMed

12.

Margonis GA, Kim Y, Samaha M, Buettner S, Sasaki K, Gani F, Amini N, Pawlik TM (2016) Blood loss and outcomes after resection of colorectal liver metastases. J Surg Res 202:473–480CrossRefPubMed

13.

Jiang W, Fang YJ, Wu XJ, Wang FL, Lu ZH, Zhang RX, Ding PR, Fan WH, Pan ZZ, De-Sen Wan (2013) Intraoperative blood loss independently predicts survival and recurrence after resection of colorectal cancer liver metastasis. PLoS ONE 8:e76125CrossRefPubMedPubMedCentral

14.

Couinaud C (1999) Liver anatomy: portal (and suprahepatic) or biliary segmentation. Dig Surg 16:459–467CrossRefPubMed

15.

Juza RM, Pauli EM (2014) Clinical and surgical anatomy of the liver: a review for clinicians. Clin Anat 27:764–769CrossRefPubMed

16.

Vibert E, Perniceni T, Levard H, Denet C, Shahri NK, Gayet B (2006) Laparoscopic liver resection. Br J Surg 93:67–72CrossRefPubMed

17.

Gayet B, Cavaliere D, Vibert E, Perniceni T, Levard H, Denet C, Christidis C, Blain A, Mal F (2007) Totally laparoscopic right hepatectomy. Am J Surg 194:685–689CrossRefPubMed

18.

Gumbs AA, Gayet B (2013) Adopting Gayet’s techniques of totally laparoscopic liver surgery in the United States. Liver. Cancer 2:5–15

19.

Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213CrossRefPubMedPubMedCentral

20.

Balzan S, Belghiti J, Farges O, Ogata S, Sauvanet A, Delefosse D, Durand F (2005) The ‘50–50 criteria’ on postoperative day 5: an accurate predictor of liver failure and death after hepatectomy. Ann Surg 242:824–828CrossRefPubMedPubMedCentral

21.

Ishizawa T, Hasegawa K, Kokudo N, Sano K, Imamura H, Beck Y, Sugawara Y, Makuuchi M (2009) Risk factors and management of ascites after liver resection to treat hepatocellular carcinoma. Arch Surg 144:46–51CrossRefPubMed

22.

Koch M, Garden OJ, Padbury R, Rahbari NN, Adam R, Capussotti L, Fan ST, Yokoyama Y, Crawford M, Makuuchi M, Christophi C, Banting S, Brooke-Smith M, Usatoff V, Nagino M, Maddern G, Hugh TJ, Vauthey JN, Greig P, Rees M, Nimura Y, Figueras J, DeMatteo RP, Büchler MW, Weitz J (2011) Bile leakage after hepatobiliary and pancreatic surgery: a definition and grading of severity by the International Study Group of Liver Surgery. Surgery 149:680–688CrossRefPubMed

23.

Yang T, Zhang J, Lu JH, Yang GS, Wu MC, Yu WF (2011) Risk factors influencing postoperative outcomes of major hepatic resection of hepatocellular carcinoma for patients with underlying liver diseases. World J Surg 35:2073–2082CrossRefPubMed

24.

Schiergens TS, Stielow C, Schreiber S, Hornuss C, Jauch KW, Rentsch M, Thasler WE (2014) Liver resection in the elderly: significance of comorbidities and blood loss. J Gastrointest Surg 18:1161–1170CrossRefPubMed

25.

Lison S, Weiss G, Spannagl M, Heindl B (2011) Postoperative changes in procoagulant factors after major surgery. Blood Coagul Fibrinolysis 22:190–196CrossRefPubMed

26.

Marietta M, Facchini L, Pedrazzi P, Busani S, Torelli G (2006) Pathophysiology of bleeding in surgery. Transplant Proc 38:812–814CrossRefPubMed

27.

Noble S, Pasi J (2010) Epidemiology and pathophysiology of cancer associated thrombosis. Br J Cancer 102:S2–S9CrossRefPubMedPubMedCentral

28.

Rahbari NN, Garden J, Padbury R, Brooke-Smith M, Crawford M, Adam R, Koch M, Makuuchi M, Dematteo RP, Christophi C, Banting S, Usatoff V, Nagino M, Maddern G, Hugh TJ, Vauthey JN, Greig P, Rees M, Yokoyama Y, Fan ST, Nimura Y, Figueras J, Capussotti L, Büchler MW, Weitz J (2011) Posthepatectomy liver failure: a definition and grading by the International Study Group of Liver Surgery (ISGLS). Surgery 149:713–724CrossRefPubMed

29.

Andersson R, Saarela A, Tranberg KG, Bengmark S (1990) Intraabdominal abscess formation after major liver resection. Acta Chir Scand 156:707–710PubMed

30.

Zimmitti G, Roses RE, Andreou A, Shindoh J, Curley SA, Aloia TA, Vauthey JN (2013) Greater complexity of liver surgery is not associated with an increased incidence of liver-related complications except for bile leak: an experience with 2628 consecutive resections. J Gastrointest Surg 17:57–65CrossRefPubMed

31.

Yamashita YI, Hamatsu T, Rikimaru T, Tanaka S, Shirabe K, Shimada M, Sugimachi K (2001) Bile leakage after hepatic resection. Ann Surg 233:45–50CrossRefPubMedPubMedCentral

32.

Nanashima A, Abo T, Shibuya A, Tominaga T, Matsumoto A, Tou K, Kunizaki M, Takeshita H, Hidaka S, Tsuchiya T, Yamasaki N (2013) Does the placement of a cystic duct tube after a hepatic resection help reduce the incidence of post-operative bile leak? HPB (Oxford) 15:517–522CrossRef

33.

Kooby DA, Stockman J, Ben-Porat L, Gonen M, Jarnagin WR, Dematteo RP, Tuorto S, Wuest D, Blumgart LH, Fong Y (2003) Influence of transfusions on perioperative and long-term outcome in patients following hepatic resection for colorectal metastases. Ann Surg 237:860–869PubMedPubMedCentral

Title: Impact of intraoperative blood loss on the short-term outcomes of laparoscopic liver resection
Authors: Rahul Gupta
David Fuks
Christophe Bourdeaux
Pejman Radkani
Takeo Nomi
Christian Lamer
Brice Gayet
Publication date: 01-11-2017
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 11/2017
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-017-5496-y

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Impact of intraoperative blood loss on the short-term outcomes of laparoscopic liver resection

Abstract

Background

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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