LIVER RESECTION WITHOUT BLOOD-TRANSFUSION

A retrospective study was carried out of 522 elective liver resections to determine the impact of blood transfusion on the immediate postope rative outcome and on long-term survival. The number of liver resectio ns without transfusion has increased in recent years, as a result of i mprovement in surgical technique with less blood loss during operation and more careful choice of the timing of transfusion. In resections c arried out in the past 5 years, the indication for intraoperative tran sfusion was restricted and the decision was made jointly by the surgeo n and anaesthetist, and in any case only if the haematocrit was below 25 per cent. Of resections carried out in the past 2 years, 59 per cen t did not require intraoperative transfusion. Postoperative deaths and complications were related to blood transfusion, particularly in pati ents with cirrhosis, in whom stepwise logistic regression analysis sho wed that transfusion was the only factor that correlated significantly with complications. Transfusion also affected the long-term survival of patients operated on for hepatocellular carcinoma and colorectal ca rcinoma metastases in univariate analysis and was the only factor show n by multivariate analysis to correlate with survival for hepatocellul ar carcinoma in patients with cirrhosis.