Atsushi Nanashima1,2, Yukinori Tanoue3,4, Tatefumi Sakae5, Isao Tsuneyoshi6, Masahide Hiyoshi3, Naoya Imamura3, Takeomi Hamada3, Koichi Yano3, Takahiro Nishida3, Mitsutoshi Ishii3,4, Takeshi Nagayasu4, Kunihide Nakamura3. 1. Division of Hepatobiliary Pancreas Surgery, Department of Surgery, University of Miyazaki Faculty of Medicine, Kiyotake 5200, Miyazaki, 889-1692, Japan. a_nanashima@med.miyazaki-u.ac.jp. 2. Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto, Nagasaki, Japan. a_nanashima@med.miyazaki-u.ac.jp. 3. Division of Hepatobiliary Pancreas Surgery, Department of Surgery, University of Miyazaki Faculty of Medicine, Kiyotake 5200, Miyazaki, 889-1692, Japan. 4. Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto, Nagasaki, Japan. 5. Department of Radiology, University of Miyazaki Faculty of Medicine, Kiyotake 5200, Miyazaki, Japan. 6. Department of Anesthesiology, University of Miyazaki Faculty of Medicine, Kiyotake 5200, Miyazaki, Japan.
Abstract
PURPOSE: Predicting increased blood loss based on anatomical intervascular relationships is essential in major hepatectomy. METHODS: We assessed 63 consecutive patients undergoing anatomical hepatectomy exposing the hepatic vein (HV) trunk at two institutes. Correlations between anatomical alterations of the hepatic inferior vena cava (IVC), HV, hepatic IVC, or right atrium (RA) and the blood loss per standard weight (BLSW) or blood transfusion (n = 18) were analyzed. The results of IVC partial clamping (PC) were additionally examined. RESULTS: The BLSW in type V-up anatomical morphology was significantly higher than that in straight type (p < 0.05). The parameters associated with an increased BLSW (> 13.5 mL/kg) were tumor size (> 4 cm), prothrombin activity (< 87%), CVP (> 7 mmHg), area of suprahepatic IVC (< 360 mm2), IVC-RA gap (> 28 mm), longitudinal angle of IVC (< 160°), and axial angle of the MHV (< 55°). A multivariate analysis revealed that a high IVC-RA gap was a significant independent risk factor (odds ratio; 4.32, p < 0.05). Among 25 patients undergoing IVC-PC, only three showed a remarkable decrease in hepatic venous bleeding. No other statistically significant differences in the surgical records were observed in most cases. CONCLUSION: The IVC-RA gap might be a promising novel predictive parameter reflecting increased blood loss leading to blood transfusion in anatomical hepatectomy.
PURPOSE: Predicting increased blood loss based on anatomical intervascular relationships is essential in major hepatectomy. METHODS: We assessed 63 consecutive patients undergoing anatomical hepatectomy exposing the hepatic vein (HV) trunk at two institutes. Correlations between anatomical alterations of the hepatic inferior vena cava (IVC), HV, hepatic IVC, or right atrium (RA) and the blood loss per standard weight (BLSW) or blood transfusion (n = 18) were analyzed. The results of IVC partial clamping (PC) were additionally examined. RESULTS: The BLSW in type V-up anatomical morphology was significantly higher than that in straight type (p < 0.05). The parameters associated with an increased BLSW (> 13.5 mL/kg) were tumor size (> 4 cm), prothrombin activity (< 87%), CVP (> 7 mmHg), area of suprahepatic IVC (< 360 mm2), IVC-RA gap (> 28 mm), longitudinal angle of IVC (< 160°), and axial angle of the MHV (< 55°). A multivariate analysis revealed that a high IVC-RA gap was a significant independent risk factor (odds ratio; 4.32, p < 0.05). Among 25 patients undergoing IVC-PC, only three showed a remarkable decrease in hepatic venous bleeding. No other statistically significant differences in the surgical records were observed in most cases. CONCLUSION: The IVC-RA gap might be a promising novel predictive parameter reflecting increased blood loss leading to blood transfusion in anatomical hepatectomy.
Authors: Junichi Shindoh; Ching-Wei D Tzeng; Thomas A Aloia; Steven A Curley; Steven Y Huang; Armeen Mahvash; Sanjay Gupta; Michael J Wallace; Jean-Nicolas Vauthey Journal: J Gastrointest Surg Date: 2013-10-16 Impact factor: 3.452
Authors: Dimitrios Moris; Diamantis I Tsilimigras; Ioannis D Kostakis; Ioannis Ntanasis-Stathopoulos; Kevin N Shah; Evangelos Felekouras; Timothy M Pawlik Journal: Eur J Surg Oncol Date: 2018-04-30 Impact factor: 4.424
Authors: Nuh N Rahbari; O James Garden; Robert Padbury; Mark Brooke-Smith; Michael Crawford; Rene Adam; Moritz Koch; Masatoshi Makuuchi; Ronald P Dematteo; Christopher Christophi; Simon Banting; Val Usatoff; Masato Nagino; Guy Maddern; Thomas J Hugh; Jean-Nicolas Vauthey; Paul Greig; Myrddin Rees; Yukihiro Yokoyama; Sheung Tat Fan; Yuji Nimura; Joan Figueras; Lorenzo Capussotti; Markus W Büchler; Jürgen Weitz Journal: Surgery Date: 2011-01-14 Impact factor: 3.982
Authors: Jörg Fuchs; Steven W Warmann; Philipp Szavay; Hans J Kirschner; Jürgen F Schäfer; Anja Hennemuth; Hans G Scheel-Walter; Holger Bourquain; Heinz O Peitgen Journal: J Pediatr Surg Date: 2005-02 Impact factor: 2.545