Decreased blood loss reduces postoperative complications in resection for hepatocellular carcinoma

BACKGROUND: The correlation between blood loss and the risk of postoperative complications was unclear in patients undergoing resection of hepatocellular carcinoma (HCC). METHODS: We studied 539 patients who had resection of HCC. Postoperative complications were recorded according to the modified Clavien-Dindo classification. Variables were compared between patients with grade III to V complications and those with no or grade I to II. A spline regression analysis was used to estimate the probability of grade III to V complications. RESULTS: Among variables, blood loss (P = 0.0001), operating time (P = 0.0001), blood transfusion (P = 0.0001), and tumor size (P = 0.02) differed significantly between patients with grade III to V and those with no or I to II. Multivariate analysis revealed that the factor most strongly related to complications was blood loss (odds ratio 1.68; 95% confidence interval [CI] 1.45-1.96, P = 0.0001). Spline regression analysis showed that an increase in blood loss was accompanied by increase in the risk of complication; when the estimated probability of grade III to V complications exceeded 50% (95% CI 30.0-70.0), the corresponding blood loss was 820 ml. CONCLUSION: Decrease in blood loss in resection of HCC is accompanied by reduced risk of complications. Surgeons need to minimize blood loss as less as 820 ml.