Impact of intraoperative hypovolemic phlebotomy on blood loss and perioperative transfusion in patients undergoing hepatectomy for cancer

Abstract

multilocular abscesses (Type III) had significantly lower failure rates following algorithmic approach with primary surgical treatment (3/32) compared to first-line antibiotics or percutaneous drainage (24/80) (9.3% versus 30.0%, p=0.021) with no 30-day mortalities for either group. Large unilocular abscesses (Type II) failed first-line percutaneous drainage in 25.5% (13/51), with 10 patients requiring escalation to surgery. Treatment of Type II abscesses with primary surgery rather than percutaneous drainage was successful in 88.2% (15/17) with no 30-day mortalities. Conclusion: Primary surgical intervention is highly successful in the treatment of large pyogenic liver abscesses. While antibiotic therapy remains the mainstay of treatment for small acute liver abscesses, in light of higher failure rates for percutaneous drainage we propose that surgical intervention should be considered for select patients with large complex abscesses as up-front definitive treatment.

Management of severe peri-operative bleeding: Guidelines from the European Society of Anaesthesiology and Intensive Care

“…A meta-analysis suggests that ANH used together with a low CVP strategy results in fewer intra-operative blood transfusions compared with using only low CVP; fibrin sealant could also be associated with lower intra-operative blood transfusion compared with no use and resection using a radiofrequency dissecting sealer may be associated with more adverse events than with the clamp-crush method 571 . Intra-operative hypovolaemic phlebotomy together with low CVP strategy resulted in lower intra-operative bleeding and transfusion rate in several observational trials in patients undergoing elective hepatectomy for cancer 574–578 . A pilot feasibility RCT found similar estimated blood loss in patients undergoing major liver resections with a low CVP strategy with intra-operative hypovolaemic phlebotomy and patients receiving standard care 579 .…”

“…571 Intra-operative hypovolaemic phlebotomy together with low CVP strategy resulted in lower intra-operative bleeding and transfusion rate in several observational trials in patients undergoing elective hepatectomy for cancer. [574][575][576][577][578] A pilot feasibility RCT found similar estimated blood loss in patients undergoing major liver resections with a low CVP strategy with intra-operative hypovolaemic phlebotomy and patients receiving standard care. 579 In a retrospective study in patients undergoing open or laparoscopic liver resection, intra-operative bleeding significantly correlated with a drop in CVP after hypovolaemic phlebotomy.…”