Risk factors associated with intra-operative blood loss in hepatectomized patients with giant cavernous hemangioma of the liver

BACKGROUND/AIMS: The aim of this study was to clarify risk factors associat ed with intra-operative blood loss in hepatectomized patients with giant ca vernous hemangioma (GCH) of the liver. METHODOLOGY: Twenty patients with GCH of the liver were treated by hepatect omy. Eleven patients with intra-operative blood loss >2000ml (mean: 7145+/- 7080m; Group 1) were reviewed retrospectively and compared to 9 patients wi th intra-operative hemorrhage <2000ml (mean: 918+/-429ml; Group 2). RESULTS: Although there were no significant differences in pre-operative AS T, ALT, and ICG-15 or fibrinogen and platelets between the two groups, pre- operative total bilirubin and fibrin degradation product (FDP) in Group 1 w as significantly higher than in Group 2. Mean operation time and intraopera tive blood transfusion in Group 1 versus Group 2 were 433min vs. 213min (p< 0.0001) and 3036ml vs. 422ml (p=0.0072), respectively. The weight of resect ed liver (r=0.821, p<0.0001), maximum diameter of tumor (r=0.782, p<0.0001) and operation time (r=0.748, p<0.0001) were the most highly correlated wit h intra-operative blood loss, followed by pre-operative total bilirubin (r= 0.605, p=0.0038), FDP level (r=0.576, p=0.0068) and intra-operative blood t ransfusion (r=0.561, p=0.0089). CONCLUSIONS: These findings suggest that pre-operative management to reduce the tumor size, total bilirubin and FDP levels may be essential to minimiz e intra-operative hemorrhage and blood transfusion.