Key result
Preoperative obstructive ventilatory impairment (FEV1.0% < 70%) independently increased the risk of massive intraoperative blood loss during laparoscopic hepatectomy (OR 2.28).
Why the study?
Animal models show hepatic vein bleeding is influenced by airway pressure, but clinical data on how airway pressure creates risk are limited.
Does obstructive ventilatory impairment increase intraoperative blood loss in patients undergoing laparoscopic hepatectomy?
Cohort (n=692)
No
Does obstructive ventilatory impairment increase intraoperative blood loss in patients undergoing laparoscopic hepatectomy?
Obstructive ventilatory impairment (FEV1.0% < 70%) is an independent risk factor for increased intraoperative blood loss during laparoscopic hepatectomy.
Purpose: An animal model of laparoscopic hepatectomy showed that bleeding from the hepatic vein is influenced by airway pressure. However, there are little research reports on how airway pressure leads to risks in clinical practice. The main objective of this study was to investigate the impact of preoperative forced expiratory volume % in 1 second (FEV1.0%) on intraoperative blood loss in laparoscopic hepatectomy.Methods:All patients who underwent pure laparoscopic or open hepatectomy from April 2011 to July 2020 were classified into two groups by preoperative spirometry: those with obstructive ventilatory impairment (Obstructive group; FEV1.0%< 70%) and those with normal respiratory function (Normal group; FEV1.0%≥ 70%). Massive blood loss was defined as 400 mL for laparoscopic hepatectomy.Results:In total, 247 and 445 patients underwent pure laparoscopic and open hepatectomy, respectively. Regarding laparoscopic hepatectomy group, blood loss was significantly greater in the Obstructive group (122 vs. 100 mL, P = 0.042). Multivariate analysis revealed that high IWATE criteria scores (≥ 7, odds ratio [OR]: 4.50, P = 0.004) and low preoperative FEV1.0% (< 70%, OR: 2.28, P = 0.043) were independent risk factors for blood loss during laparoscopic hepatectomy. In contrast, FEV1.0% did not affect the blood loss (522 vs. 605 mL, P = 0.113) during open hepatectomy. Conclusion: Obstructive ventilatory impairment (low FEV1.0%) may affect the amount of bleeding during laparoscopic hepatectomy.
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Nakamura et al. (2022) conducted a cohort in Hepatocellular carcinoma or metastatic liver cancer (n=692). Obstructive ventilatory impairment (FEV1.0% < 70%) vs. Normal respiratory function (FEV1.0% ≥ 70%) was evaluated on Massive intraoperative blood loss (≥ 400 mL) during laparoscopic hepatectomy (OR 2.28, 95% CI 1.02-5.10, p=0.043). Preoperative obstructive ventilatory impairment (FEV1.0% < 70%) independently increased the risk of massive intraoperative blood loss during laparoscopic hepatectomy (OR 2.28).
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