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Decreased blood loss reduces postoperative complications in resection for hepatocellular carcinoma
Osamu Aramaki1, Tadatoshi Takayama, Tokio Higaki
1Department of Digestive Surgery, Nihon University School of Medicine, 30-1 Ohyaguchikami-machi, Itabashi-ku, Tokyo, 173-8610, Japan.
Insights
Minimizing blood loss during hepatocellular carcinoma (HCC) resection significantly reduces the risk of severe postoperative complications. Surgeons should aim to limit blood loss to below 820 ml to improve patient outcomes.
Area of Science:
- Hepatobiliary surgery
- Surgical oncology
- Clinical outcomes research
Background:
- The relationship between intraoperative blood loss and postoperative complications following hepatocellular carcinoma (HCC) resection remains incompletely understood.
- Identifying key risk factors for severe complications is crucial for improving surgical safety in HCC patients.
Purpose of the Study:
- To investigate the association between blood loss and the incidence of severe postoperative complications (grade III-V) in patients undergoing HCC resection.
- To establish a threshold for blood loss associated with a high probability of severe complications.
Main Methods:
- A retrospective study of 539 patients who underwent HCC resection.
- Complications were classified using the modified Clavien-Dindo system.
- Spline regression analysis was employed to model the probability of severe complications as a function of blood loss.
Main Results:
- Blood loss, operating time, blood transfusion, and tumor size were significantly associated with severe complications.
- Multivariate analysis identified blood loss as the strongest predictor (OR 1.68; 95% CI 1.45-1.96; P < 0.0001).
- A blood loss of 820 ml corresponded to an estimated 50% probability of grade III-V complications.
Conclusions:
- Reducing intraoperative blood loss is critical for minimizing severe postoperative complications after HCC resection.
- Surgeons should strive to maintain blood loss below 820 ml to enhance patient safety and outcomes.
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.
Conclusion:
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.
