PREDICTION AND LIMITATION OF HEPATIC TUMOR RESECTION WITHOUT BLOOD-TRANSFUSION IN CIRRHOTIC-PATIENTS

Background: The need for blood transfusion in cirrhotic liver resectio n is difficult to determine because of inaccurate estimation of operat ive blood loss. Moreover, blood transfusion is detrimental to cirrhoti c patients. Objective: To investigate the predictors and limitations o f hepatectomy without blood transfusion for cirrhotic patients. Design : Retrospective study. Setting: University hospital, a tertiary referr al center. Patients: A consecutive 163 cirrhotic patients underwent re section for liver tumor(s) under a policy of restrictive blood transfu sion. interventions: Estimated blood losses and clinicopathological fe atures of patients who received and those who did not receive a blood transfusion were compared. Main Outcome Measures: Estimated operative blood losses, preoperative assessments, and operative procedures. Resu lts: There were 48 patients in the group who received a blood transfus ion, with 1275 +/- 650 mt (mean +/- SE) of blood transfused, and 115 p atients in the group who did not receive a blood transfusion. From dis criminant analysis, the cutoff value of estimated blood loss for blood transfusion was 1685 mt. Tumor size and site of hepatectomy were foun d to be independent variables influencing blood transfusion under logi stic regression analysis. Conclusions: Most cirrhotic patients tolerat e hepatectomy without blood transfusion when the estimated operative b lood loss is less than 1600 mt. Hepatectomy can be performed in cirrho tic patients without blood transfusion if the tumor is small (<5 cm), and/or the resection area is confined to Couinaud segments II, III, an d VI. In this study, the largest amount of estimated blood loss in cir rhotic liver resection without blood transfusion was 2350 mt, but the uppermost limit remains to be determined.