One hundred consecutive hepatic resections. Blood loss, transfusion, and operative technique
J. D. Cunningham, Y. Fong, C. Shriver, J. Melendez, W. L. Marx and L. H. Blumgart
Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY.
BACKGROUND: Hepatic resection is prone to significant blood loss. Adverse
effects of blood loss and transfusion mandate improvements in surgical
techniques to reduce blood loss and transfusion requirements. METHODS: One
hundred hepatic resections were carried out using a standard surgical
technique that includes control of the hilar structures, extrahepatic
control of the hepatic veins, and use of the Pringle maneuver. Low central
venous pressure and Trendelenburg positioning were used during parenchymal
transection. Data were collected retrospectively in the first 36 patients,
whereas data were collected prospectively in the remaining 64 patients.
RESULTS: Hospital mortality was 3%. Median blood loss was 450, 700, 1000,
1100, and 1500 mL for segmental, nonanatomic, lobar, extended right, and
extended left resections, respectively. Major resections were more likely
than minor resections to be transfused with albumin (P = .008), fresh
frozen plasma (P = .009), and packed red blood cells or whole blood (P =
.04). Overall transfusion of packed red blood cells or whole blood occurred
in 59 of 100 patients. In the 64 patients who were followed up
prospectively, the predeposit of autologous blood decreased the need for
homologous transfusions from 56% to 38%. A further reduction in the
transfusion rate of 25% could have been possible if all patients in the
prospective group had donated 2 U of autologous blood. Patients who
predeposited blood were more likely to receive transfusions and to have had
a transfusion more than 24 hours after surgery than were patients who did
not donate blood. CONCLUSIONS: The surgical techniques used results in
acceptable blood loss and transfusion requirements for hepatic resection.
This approach is safe, cost-effective, reproducible, and applicable for
widespread use.
