Intra-operative blood loss predicts complications after a second hepatectomy for malignant neoplasms.

OBJECTIVE

We investigated the risk of morbidity after repeat resections for liver recurrence of hepatocellular carcinoma or for colorectal liver metastases.

BACKGROUND DATA

Although repeat hepatectomy for recurrences of hepatocellular carcinoma or for colorectal cancer liver metastases is well known only to carry risks similar to those seen for an initial liver resection, the safety of such a procedure is questionable because, typically, only a few liver tumors are thought suitable for repeat hepatectomy.

METHODS

Clinicopathology data were available for 412 hepatectomy patients (hepatocellular carcinoma in 226, colorectal liver metastases in 186). Risk factors for postoperative complications were analyzed retrospectively among the 57 patients undergoing a repeat hepatectomy.

RESULTS

Using multivariate analysis, intraoperative blood loss (relative risk, 9.61; P = 0.02) affected the occurrence of postoperative complications after a second hepatectomy. In patients who lost more than 1.29 l blood intraoperatively at the second hepatectomy, a major hepatectomy (P < 0.05) by means of an anatomical type of resection (P < 0.01) was more often performed than in the patients with 1.29 l or less of blood loss.

CONCLUSIONS

The major independent risk factor associated with complications after a second hepatectomy for liver recurrence was intraoperative blood loss. The extent of liver resection, especially in an anatomical manner, directly influences the amount of blood loss.