Operative blood loss independently predicts recurrence and survival after resection of hepatocellular carcinoma Journal Article
| Authors: | Katz, S. C.; Shia, J.; Liau, K. H.; Gonen, M.; Ruo, L.; Jarnagin, W. R.; Fong, Y.; D'Angelica, M. I.; Blumgart, L. H.; DeMatteo, R. P. |
| Article Title: | Operative blood loss independently predicts recurrence and survival after resection of hepatocellular carcinoma |
| Abstract: | OBJECTIVE: To determine if the degree of blood loss during resection of hepatocellular carcinoma (HCC) is predictive of recurrence and long-term survival. BACKGROUND: Several studies have addressed the impact of blood transfusion on survival and recurrence after liver resection for HCC. However, the independent effect of intraoperative estimated blood loss (EBL) on oncologic outcome is unclear. METHODS: From our prospective database, we identified 192 patients who had a partial hepatectomy for HCC from 1985 to 2002. Clinicopathologic predictors of EBL were identified using logistic regression. Overall survival (OS), disease-specific survival (DSS), and recurrence free survival (RFS) were assessed using the Kaplan-Meier and Cox regression methods. RESULTS: The median patient age was 64 (range, 19-86) and 66% were men. All patients had histologically proven HCC. The median follow-up time was 34 months (range, 1-297). Factors associated with increased EBL on multivariate analysis were male gender, vascular invasion, extent of hepatectomy, and operative time (P < 0.01). EBL and vascular invasion were independent predictors of OS and DSS. Only EBL was significantly associated with RFS on multivariate analysis (P =0.02). Additionally, we found a significant inverse correlation between increasing levels of EBL and length of DSS (P =0.01). CONCLUSIONS: The magnitude of EBL during HCC resection is related to biologic characteristics of the tumor as well as the extent of surgery. Increased intraoperative blood loss during HCC resection is an independent prognostic factor for tumor recurrence and death. © 2009 by Lippincott Williams & Wilkins. |
| Keywords: | survival; adult; cancer survival; human tissue; aged; aged, 80 and over; middle aged; survival analysis; cancer surgery; retrospective studies; young adult; major clinical study; mortality; cancer recurrence; liver cell carcinoma; carcinoma, hepatocellular; liver neoplasms; cancer staging; methodology; neoplasm staging; neoplasm recurrence, local; bleeding; age factors; pathology; retrospective study; risk factor; cancer mortality; age; risk assessment; postoperative complication; postoperative complications; register; registries; proportional hazards model; probability; tumor recurrence; liver tumor; prediction and forecasting; predictive value of tests; liver resection; hepatectomy; multivariate analysis; sex difference; kaplan meier method; sex factors; blood loss, surgical; partial hepatectomy |
| Journal Title: | Annals of Surgery |
| Volume: | 249 |
| Issue: | 4 |
| ISSN: | 0003-4932 |
| Publisher: | Lippincott Williams & Wilkins |
| Date Published: | 2009-04-01 |
| Start Page: | 617 |
| End Page: | 623 |
| Language: | English |
| DOI: | 10.1097/SLA.0b013e31819ed22f |
| PUBMED: | 19300227 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 12" - "Export Date: 30 November 2010" - "CODEN: ANSUA" - "Source: Scopus" |
Altmetric
Citation Impact
BMJ Impact Analytics
MSK Authors
Related MSK Work