Risk factors associated with intra-operative major blood loss in patients with hepatocellular carcinoma who underwent hepatic resection.

Background: Minimizing intraoperative blood loss during hepatectomy for hepatocellular carcinoma (HCC) decreases the need for blood transfusion. The purpose of this study was to investigate the risk factors associated with major blood loss in performing liver resection for HCC.

Methods: A total of 643 consecutive patients who underwent hepatic resection for HCC were included in this retrospective study. Patients were divided into groups according to the intraoperative blood loss. Blood loss more than 1,000 mL was defined as major blood loss. Twenty-eight variables were analyzed.

Results: As compared with patients with blood loss < 1,000 mL, patients with major blood loss had worse disease-free and overall survival rates (p < 0.001). Patients with major blood loss had higher surgical morbidity, mortality and prolonged hospital stay (p < 0.001). Multivariate analysis shows that independent risk factors associated with major blood loss include: male gender, alanine aminotrasferase > 55U/dL, prothrombin time < 95%, resection more than 3 Couinaud segments, en bloc resection, surgeon with low case volume (< 65 cases) and tumor with central location.

Conclusions: Hemorrhage control is the main problem in liver resection for HCC. In patients with risk factors of major bleeding, it is essential to take effective measure in order to minimize intraoperative blood loss in hepatectomy for patients with HCC.