Patient Blood Management in Hepatobiliary and Pancreatic Surgery

Patients undergoing hepatobiliary and pancreatic (HBP) surgery often need to be transfused, despite advances in surgical skills and perioperative care. However, many studies have indicated that cancer patients who are transfused have higher rates of perioperative mortality and cancer recurrence, and poorer prognoses [1]. Moreover, viral or bacterial infections, immunologic reactions, and increased postoperative morbidity are other adverse consequences of allogeneic transfusions. Furthermore, since there are not enough blood donors in Korea to supply the demand, new treatment strategies for HBP patients are needed. Patient blood management (PBM) programs, medical care without allogeneic blood transfusion, have traditionally been applied in various clinical situations, e.g., when patients refuse to be transfused for religious reasons, when there is no blood to transfuse, and when safe blood is not available [2]. Although PBM is a relatively new technology in the field of HBP surgery, its general concepts are very similar to those of traditional PBM. The basic concepts of PBM applicable to the perioperative and intraoperative method have recently been described. Erythropoietin, ferritin, vitamin B12, or volume expanders and preoperative autologous blood donation (PAD) are used in perioperative PBM. Intraoperative management includes acute normovolemic hemodilution (ANH), cell salvage (Cell Saver®), and hypotensive anesthesia. Although the disadvantages of transfusion and the advantages of PBM are widely recognized, few studies have evaluated the beneficial effects of PBM in HBP surgery. Although the use of PBM in HBP operations without transfusion (including pancreaticoduodenectomy for periampullary lesions, living donor liver transplantation, and major hepatectomy) has been reported in the past few years, it is inherently challenging to carry out researches on transfusion-related issues because reasons and sequelae of transfusion are multifactorial [3-6]. The goal of this article is to review the current status of PBM programs in HBP surgery. Review