Yamamoto J, Kosuge T, Takayama T, Shimada K, Yamasaki S, Ozaki H, Yamaguchi N, Mizuno S, Makuuchi M
Department of Surgery, National Cancer Center Hospital, Tokyo, Japan.
Surgery. 1994 Mar;115(3):303-9.
Recent advances in liver surgery have reduced operative blood loss drastically, and in more than one half of the patients in our hospital, the liver resection can be accomplished without blood transfusion.
Two hundred fifty-two patients who underwent complete resection for hepatocellular carcinoma (HCC) were evaluated to assess the effect of perioperative blood transfusion on the recurrence of carcinoma.
Carcinoma recurred in 55 (74.3%) of the 74 patients who received a transfusion, but in only 89 (50%) of the 178 patients who did not receive a transfusion (p = 0.0001). This effect was significant even when only a small amount of blood was transfused (p = 0.0001). Based on multivariate analysis, perioperative blood transfusion was a significant predictor for accelerated recurrence (p = 0.003), as were tumor invasiveness (vascular invasion or intrahepatic metastasis) (p = 0.0008) and background liver cirrhosis (p = 0.04). The recurrence-promoting effect of blood transfusion was markedly significant when the patient had either noninvasive HCC (p = 0.0005) or a cirrhotic liver (p < 0.0001).
These results strongly suggest that perioperative blood transfusion substantially promotes the recurrence of HCC after hepatectomy. This effect must be considered and added to the risks of perioperative blood transfusion when formulating a surgical strategy for HCC.
肝脏手术的最新进展已大幅减少手术失血，在我院超过一半的患者中，肝切除可在不输血的情况下完成。
对252例行肝细胞癌（HCC）根治性切除的患者进行评估，以评估围手术期输血对癌复发的影响。
74例接受输血的患者中有55例（74.3%）出现癌复发，而178例未输血的患者中只有89例（50%）复发（p = 0.0001）。即使仅输注少量血液，这种影响也很显著（p = 0.0001）。基于多因素分析，围手术期输血是加速复发的显著预测因素（p = 0.003），肿瘤侵袭性（血管侵犯或肝内转移）（p = 0.0008）和背景肝硬化（p = 0.04）也是如此。当患者患有非侵袭性HCC（p = 0.0005）或肝硬化肝脏（p < 0.0001）时，输血的促复发作用明显显著。
这些结果强烈表明，围手术期输血显著促进肝切除术后HCC的复发。在制定HCC的手术策略时，必须考虑这种影响并将其纳入围手术期输血的风险之中。
