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Introduction
Liver surgeries have become relatively safe due to the development of surgical instruments and improved surgical techniques. Various facilities have been taking measures such as lowering central venous pressure and airway pressure, and occlusing blood inflow to the liver using the Pringle maneuver method to prevent intraoperative bleeding.1,2
However, in digestive surgery, blood transfusion-free hepatectomy is less frequent than upper- and lower-gastrointestinal tract surgery and has a high risk of perioperative bleeding because the liver is an organ with abundant blood flow, and many diseases targeted for hepatectomy are hepatocellular carcinoma (HCC). Decreased coagulation and hemostatic ability due to the coexistence of chronic anemia (from the underlying disease) before surgery and an impaired liver with conditions such as chronic hepatitis and cirrhosis are possible factors. Therefore, the history of liver surgery is the history of bleeding control in hepatectomy.
This study compares the surgical results with and without use of allogeneic transfusion during hepatectomy and discusses the postoperative effects.
Methods
Patient Population and Selection
We retrospectively reviewed the data of 374 consecutive patients who underwent resection for HCC at Osaka Medical College Hospital, Takatsuki City, Japan, between January 6, 2010 and December 25, 2018. Patients whose procedures involved a biliary-enteric anastomosis or a gastrointestinal component (ie, colorectal resection) were excluded from the study. In addition, patients who underwent a noncurative resection or additional treatments, such as repeated hepatic resection or radiofrequency ablation, during the first 6 postoperative months were also excluded. A total of 358 patients who underwent hepatic resection and liver volumetry at 3 time points were finally included in this retrospective study. All patients were fully informed of the study design and provided written informed consent for participation. The study design was approved by the Ethics Committee on Clinical Investigation of the Osaka Medical College Hospital (approval numbers 2001 and 2059).
Surgical Procedure
All procedures were performed under general anesthesia by 2 experienced hepatobiliary surgeons (YI and KU). The open and laparoscopic surgical techniques routinely used in our department have been described previously.2-5 A tumor size of <10 cm was the main criterion when considering a patient for laparoscopic hepatectomy, and the number and locations of tumors were not considered. The indication for laparoscopic hepatectomy was no more than...