Risk Factors Associated with Major Intraoperative Blood Loss in Hepatic Resection for Hepatobiliary Tumor Boonchoo Sirichindakul MD*, Rawisak Chanwat MD*, Bunthoon Nonthasoot MD*, Jade Suphapol MD*, Supanit Nivatvongs MD*
* Department of Surgery, Faculty of Medicine, Chulalongkorn University
Affiliation :
Background and
Purpose : Hepatic resection is the mainstay treatment of hepatobiliary tumor. Nowadays,
mortality is less than 6%. However, morbidity is still high. Bleeding is one of the most common problems during
hepatic resection which can sometimes lead to catastrophe. The purpose of the present study was to investi-
gate the risk factors associated with major blood loss during hepatic resection for hepatobiliary tumor.
Materials and Methods : A total of 69 consecutive patients who underwent elective hepatic resection for
hepatobiliary tumor from May 2002 to April 2004 were enrolled into this retrospective study.The Patients
were divided into 2 groups(group I and II) according to the intraoperative blood loss. Patients who had a
blood loss of more than 1,000 ml were defined as the major blood loss group(groupI). Thirteen variable factors
were analyzed to determine the risk of major intraoperative blood loss. Operative outcomes between the two
groups were also compared.
Results : Of the sixty-nine patients, 36 patients were in group I and 33 patients were in group II. 75% of the
patients in group I and 36.4% of the patients in group II were transfused. Median blood transfusion in group
I and II were 3 and 0 units of packed red cell. Univariate analysis showed tumor size, extent of hepatic
resection , tumor pathology and operative time were factors affecting major intraoperative blood loss. How-
ever, multivariate analysis showed only operative time and tumor size to be independent risk factors. Patients
in group I had higher surgical morbidity and prolonged hospital stay compared with patients in group II.
Conclusion : Blood loss is still a major concern in performing hepatic resection. From the present study, tumor
size and operative time are the independent factors affecting major intraoperative blood loss. Proper screen-
ing or a surveillance program may enhance the chance to find small tumors. Refined operative techniques
such as anterior approach and liver hanging would facilitate resection for large right sided tumors.
Keywords : Liver neoplasm, Hepatectomy, Blood transfusions
