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Area of Science:

  • Hepatobiliary Surgery
  • Pulmonary Medicine
  • Anesthesiology

Background:

  • Restrictive pulmonary dysfunction (RPD) is a known risk factor for perioperative complications in gastrointestinal surgery.
  • High airway pressure associated with RPD may increase intraoperative blood loss during liver surgery.
  • The impact of RPD on perioperative outcomes in liver resection warrants investigation.

Purpose of the Study:

  • To investigate the effect of restrictive pulmonary dysfunction (RPD) on perioperative outcomes in patients undergoing liver resection.
  • To determine if RPD is associated with increased intraoperative blood loss during liver surgery.
  • To identify RPD as a potential risk factor for complications in liver resection patients.

Main Methods:

  • A retrospective study included 496 patients undergoing curative liver resection from April 2009 to April 2020.
  • Patients were categorized into groups based on the presence of restrictive pulmonary dysfunction (RPD), defined as % vital capacity <80%.
  • Perioperative outcomes, including intraoperative blood loss and complication rates, were compared between RPD and control groups, with a subgroup analysis for anatomical liver resection.

Main Results:

  • Overall, no significant differences in blood loss or complication rates were found between patients with and without RPD.
  • In patients undergoing anatomical liver resection, those with RPD experienced significantly higher intraoperative blood loss (925 mL vs 456 mL, P = .013).
  • Multivariate analysis identified RPD as an independent risk factor for substantial intraoperative blood loss (≥500 mL) specifically during anatomical liver resection (OR 4.132, P = .031).

Conclusions:

  • Restrictive pulmonary dysfunction (RPD) may be an independent risk factor for increased intraoperative blood loss during anatomical liver resection.
  • The findings suggest that RPD's impact is significant in liver resections requiring exposure of the main hepatic vein.
  • Further research may be needed to explore strategies to mitigate bleeding risks in RPD patients undergoing anatomical liver resection.