Impact of intraoperative blood loss on postoperative morbidity after liver resection for primary and secondary liver cancer.

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb Pub Date : 2025-02-06 DOI:10.1016/j.hpb.2025.01.010

Abdullah Altaf, Miho Akabane, Mujtaba Khalil, Zayed Rashid, Shahzaib Zindani, Jun Kawashima, Andrea Ruzzenente, Luca Aldrighetti, Todd W Bauer, Hugo P Marques, Guillaume Martel, Irinel Popescu, Mathew J Weiss, Minoru Kitago, George Poultsides, Shishir K Maithel, Vincent Lam, Tom Hugh, Ana Gleisner, Kazunari Sasaki, Federico Aucejo, Carlo Pulitano, Feng Shen, François Cauchy, Bas G Koerkamp, Itaru Endo, Timothy M Pawlik

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引用次数: 0

Abstract

Background: We sought to determine the association between intraoperative blood loss (IBL) and postoperative morbidity among patients undergoing surgery for liver cancer.

Methods: Patients undergoing surgery for primary and secondary liver cancer were identified from a multi-institutional database. Adjusted blood loss (aBL) was calculated by normalizing IBL to body weight; the comprehensive complication index (CCI) was used to evaluate postoperative complications.

Results: A total of 2491 patients were included. Mean CCI was 10.6 (±5.2) for patients with aBL <10 mL/kg versus 15.2 (±7.2) for individuals with aBL ≥10 mL/kg (p < 0.001). On cubic spline regression, a nonlinear correlation between aBL and CCI was observed. CCI increased exponentially for aBL ranging from 5 to 10 mL/kg, then reached a plateau between an aBL of 10-30 mL/kg before dramatically increasing for aBL >30 mL/kg. Recursive partitioning technique demonstrated that an aBL threshold of 8.5 mL/kg best distinguished CCI (p < 0.001). Additionally, patients with an aBL ≥8.5 mL/kg had worse recurrence-free and overall survival versus patients with an aBL <8.5 mL/kg.

Conclusion: A nonlinear incremental correlation between aBL and CCI was identified among patients undergoing surgery for liver cancer. Maintaining an aBL <8.5 mL/kg during LR may help reduce postoperative morbidity.

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术中出血量对原发性和继发性肝癌肝切除术后发病率的影响。

背景：我们试图确定肝癌手术患者术中出血量（IBL）与术后发病率之间的关系。方法：从多机构数据库中确定接受原发性和继发性肝癌手术的患者。调整失血量（aBL）按IBL与体重的比值计算；采用综合并发症指数（CCI）评价术后并发症。结果：共纳入2491例患者。aBL 30 mL/kg患者的平均CCI为10.6（±5.2）。递归划分技术表明，aBL阈值为8.5 mL/kg是区分CCI的最佳阈值(p)。结论：在肝癌手术患者中，aBL与CCI之间存在非线性增量相关性。维护aBL

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Hpb GASTROENTEROLOGY & HEPATOLOGY-SURGERY

CiteScore

5.60

自引率

3.40%

发文量

244

审稿时长

57 days

期刊介绍： HPB is an international forum for clinical, scientific and educational communication. Twelve issues a year bring the reader leading articles, expert reviews, original articles, images, editorials, and reader correspondence encompassing all aspects of benign and malignant hepatobiliary disease and its management. HPB features relevant aspects of clinical and translational research and practice. Specific areas of interest include HPB diseases encountered globally by clinical practitioners in this specialist field of gastrointestinal surgery. The journal addresses the challenges faced in the management of cancer involving the liver, biliary system and pancreas. While surgical oncology represents a large part of HPB practice, submission of manuscripts relating to liver and pancreas transplantation, the treatment of benign conditions such as acute and chronic pancreatitis, and those relating to hepatobiliary infection and inflammation are also welcomed. There will be a focus on developing a multidisciplinary approach to diagnosis and treatment with endoscopic and laparoscopic approaches, radiological interventions and surgical techniques being strongly represented. HPB welcomes submission of manuscripts in all these areas and in scientific focused research that has clear clinical relevance to HPB surgical practice. HPB aims to help its readers - surgeons, physicians, radiologists and basic scientists - to develop their knowledge and practice. HPB will be of interest to specialists involved in the management of hepatobiliary and pancreatic disease however will also inform those working in related fields. Abstracted and Indexed in: MEDLINE® EMBASE PubMed Science Citation Index Expanded Academic Search (EBSCO) HPB is owned by the International Hepato-Pancreato-Biliary Association (IHPBA) and is also the official Journal of the American Hepato-Pancreato-Biliary Association (AHPBA), the Asian-Pacific Hepato Pancreatic Biliary Association (A-PHPBA) and the European-African Hepato-Pancreatic Biliary Association (E-AHPBA).