Hemostatic parameters after hepatectomy for cancer

Area of Science:

• Hepatobiliary surgery
• Anesthesiology
• Hematology

Background:

• Epidural analgesia can improve outcomes after hepatectomy for cancer.
• Hepatectomy involves complex factors like disease, surgery, and blood loss, potentially altering hemostasis.
• This may theoretically increase the risk of epidural hematoma.

Purpose of the Study:

• To quantify hemostatic changes after hepatectomy for cancer.
• To assess the potential increased risk of epidural hematoma in these patients.

Main Methods:

• Retrospective review of 229 patients undergoing hepatectomy.
• Analysis of hemostatic parameters (INR, prothrombin time, aPTT, platelet count) in 143 patients up to postoperative day 3.

Main Results:

• Significant derangements in international normalized ratio (INR), prothrombin time, activated partial thromboplastin time (aPTT), and platelet counts were observed.
• Peak derangements typically occurred around postoperative day 2.
• Amount of liver resected and preoperative Model for End-Stage Liver Disease score predicted peak INR > or = 1.5.

Conclusions:

• Commonly measured hemostatic parameters are significantly altered after hepatectomy for cancer.
• The clinical significance of these hemostatic changes regarding neuraxial hematoma risk is uncertain.
• Clinicians must carefully weigh the risks and benefits of neuraxial blocks in hepatectomy patients, considering alternative analgesia like patient-controlled intravenous morphine.