Red blood cell transfusion in liver resection

Latchana, Nicholas; Hirpara, Dhruvin H.; Hallet, Julie; Karanicolas, Paul J.

doi:10.1007/s00423-018-1746-2

Cited by 37 publications

(18 citation statements)

References 88 publications

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“…Thus, blood loss occurs during both transection and reperfusion of the liver. This may also be attributed to the characteristics of the population which includes mostly hepatic tumors and extensive resections[ 52 ].…”

Section: Discussionmentioning

confidence: 99%

Metalloproteinase expression after desflurane preconditioning in hepatectomies: A randomized clinical trial

Koraki

Mantzoros

Chatzakis

et al. 2020

WJH

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BACKGROUND Hepatectomy with inflow occlusion results in ischemia-reperfusion injury; however, pharmacological preconditioning can prevent such injury and optimize the postoperative recovery of hepatectomized patients. The normal inflammatory response after a hepatectomy involves increased expression of metalloproteinases, which may signal pathologic hepatic tissue reformation. AIM To investigate the effect of desflurane preconditioning on these inflammatory indices in patients with inflow occlusion undergoing hepatectomy. METHODS This is a single-center, prospective, randomized controlled trial conducted at the 4 th Department of Surgery of the Medical School of Aristotle University of Thessaloniki, between August 2016 and December 2017. Forty-six patients were randomized to either the desflurane treatment group for pharmacological preconditioning (by replacement of propofol with desflurane, administered 30 min before induction of ischemia) or the control group for standard intravenous propofol. The primary endpoint of expression levels of matrix metalloproteinases and their inhibitors was determined preoperatively and at 30 min posthepatic reperfusion. The secondary endpoints of neutrophil infiltration, coagulation profile, activity of antithrombin III (AT III), protein C (PC), protein S and biochemical markers of liver function were determined for 5 d postoperatively and compared between the groups. RESULTS The desflurane treatment group showed significantly increased levels of tissue inhibitor of metalloproteinases 1 and 2, significantly decreased levels of matrix metalloproteinases 2 and 9, decreased neutrophil infiltration, and less profound changes in the coagulation profile. During the 5-d postoperative period, all patients showed significantly decreased activity of AT III, PC and protein S ( vs baseline values, P < 0.05). The activity of AT III and PC differed significantly between the two groups from postoperative day 1 to postoperative day 5 ( P < 0.05), showing a moderate drop in activity of AT III and PC in the desflurane treatment group and a dramatic drop in the control group. Compared to the control group, the desflurane treatment group also had significantly lower international normalized ratio values on all postoperative days ( P < 0.005) and lower serum glutamic oxaloacetic transaminase and serum glutamic pyruvic transaminase values on postoperative days 2 and 3 ( P < 0.05). Total length of stay was significantly less in the desflurane group ( P = 0.009). CONCLUSION Desflurane preconditioning can lessen the inflammatory response related to ischemia-reperfusion injury and may shorten length of hospitalization.

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Section: Discussionmentioning

confidence: 99%

Metalloproteinase expression after desflurane preconditioning in hepatectomies: A randomized clinical trial

Koraki

Mantzoros

Chatzakis

et al. 2020

WJH

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“…Over the past decades, improvements in surgical and perioperative care have contributed to reduce peri-operative mortality after hepatectomy [ 6 , 7 ], which lies around 3% in many cohorts [ 8 , 9 ]. With evidence supporting that parenchymal bleeding and blood transfusions associated with poor outcomes providing the impetus to achieve vascular control during liver resection [ 10 , 11 , 12 , 13 ], a classical approach for minimizing surgical blood loss is to interrupt liver blood inflow during parenchymal transection. Liver pedicle clamping, or the Pringle maneuver, was first described by James Hogarth Pringle in the beginning of the 20th century as a way to control hemorrhaging for patients with liver trauma [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

Shorter Survival after Liver Pedicle Clamping in Patients Undergoing Liver Resection for Hepatocellular Carcinoma Revealed by a Systematic Review and Meta-Analysis

Wassmer

Moeckli

Berney

et al. 2021

Cancers

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Liver pedicle clamping minimizes surgical bleeding during hepatectomy. However, by inducing ischemia-reperfusion injury to the remnant liver, pedicle clamping may be associated with tumor recurrence in the regenerating liver. Hepatocellular carcinoma (HCC) having a high rate of recurrence, evidences demonstrating an eventual association with pedicle clamping is strongly needed. We did a systematic review of the literature until April 2020, looking at studies reporting the impact of liver pedicle clamping on long-term outcomes in patients undergoing liver resection for HCC. Primary and secondary outcomes were overall survival (OS) and disease-free survival, respectively. Results were obtained by random-effect meta-analysis and expressed as standardized mean difference (SMD). Eleven studies were included, accounting for 8087 patients. Results of seven studies were pooled in a meta-analysis. Findings indicated that, as compared to control patients who did not receive liver pedicle clamping, those who did had a significantly shorter OS (SMD = −0.172, 95%CI: −0.298 to −0.047, p = 0.007, I2 = 76.8%) and higher tumor recurrence rates (odds ratio 1.36 1.01 to 1.83. p = 0.044, I2 = 50.7%). This meta-analysis suggests that liver pedicle clamping may have a deleterious impact on long-term outcomes. An individual patient-data meta-analysis of randomized trials evaluating liver pedicle clamping is urgently needed.

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“…One of the major issues in liver resection is the intraoperative control of bleeding. Intraoperative blood loss is associated with increased mortality; therefore, various techniques are used to reduce parenchymal bleeding [1]. Over the years, many techniques of temporary hepatic ischemia have been proposed that rely on the selective or complete, continuous, or temporary occlusion of the hepatic vessels [2,3].…”

Section: Introductionmentioning

confidence: 99%

Long-Term Effects of Pedicle Clamping during Major Hepatectomy for Colorectal Liver Metastases

Krawczyk

Morawski

Krasnodębski

et al. 2021

JCM

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The use of the Pringle maneuver (PM) varies widely among surgical departments. Its use depends on the operator and type of liver resection. The aim of this study was to determine the impact of the PM on patient outcomes when undergoing major liver resections. This retrospective study comprised 179 colorectal liver metastasis patients from two liver centers from Leeds and Warsaw. Only right or right extended hepatectomies with negative oncological margins were included. The primary outcome measure was the 5-year overall survival (OS). The PM was applied during 60 (33.5%) major hepatectomies included in the study and was associated with a higher peak 3-day postoperative bilirubin concentration (p = 0.002), yet not with the peak 3-day alanine aminotransferase activity (p = 0.415). The 5-year OS after liver resections with the PM and without the PM were 55.0% and 33.4%, respectively (p = 0.019). Following stratification by the Tumor Burden Score, after resections with the use of the PM, superior survival was particularly found in the subgroup of patients at intermediate risk of recurrence (p = 0.004). However, the use of the PM had no significant effect on the 5-year overall survival following adjustment for the confounding effect of the carcinoembryonic antigen concentration (p = 0.265). The use of the PM had no negative effects on the long-term outcomes in patients undergoing major, oncologically radical liver resections for colorectal metastases.

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Red blood cell transfusion in liver resection

Cited by 37 publications

References 88 publications

Metalloproteinase expression after desflurane preconditioning in hepatectomies: A randomized clinical trial

Metalloproteinase expression after desflurane preconditioning in hepatectomies: A randomized clinical trial

Shorter Survival after Liver Pedicle Clamping in Patients Undergoing Liver Resection for Hepatocellular Carcinoma Revealed by a Systematic Review and Meta-Analysis

Long-Term Effects of Pedicle Clamping during Major Hepatectomy for Colorectal Liver Metastases

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