Laparoscopic hepatectomy for hepatocellular carcinoma: short- and long-term outcomes with blood loss

Background: Laparoscopic hepatectomy (LH) for treating hepatocellular carcinoma (HCC) is a complex procedure. Compared to open hepatectomy (OH), LH offers certain advantages such as faster recovery, smaller incisions, and shorter hospital stay, but bleeding during LH remains a significant concern. Currently, the impacts of blood loss on the short- and long-term outcomes of patients undergoing LH are poorly understood. This retrospective study analyzes the impacts of blood loss on the prognosis of LH in HCC patients.

Methods: Between 2001 and 2019, 192 patients underwent LH for HCC at a single high-volume center. These patients were divided into two groups according to intraoperative blood loss (IBL) (Group A: ≤250 mL; Group B: >250 mL). The patient characteristics assessed included age, gender, cirrhosis, hepatitis B virus (HBV) infection, Child-Pugh class, number of tumors, tumor size, vascular invasion, and diabetes mellitus. The perioperative and postoperative factors compared included operative time, blood loss, type of resection, blood transfusion, general complications, surgical complications, hospital mortality, and postoperative hospital stay.

Results: Factors associated with IBL in our multivariate analysis included the type of resection (P<0.01) and operative time (P<0.01). IBL, tumor size and number of tumors were independent predictors of a patient's overall survival (OS) and recurrence-free survival (RFS). Through our subgroup multivariate analysis, we found that IBL was the only significant factor associated with RFS (P<0.02). There was also a noted IBL "dose effect", as patients with IBL >1,000 mL had a worse median OS (24 months) and median RFS (6 months), while patients with IBL 250-1,000 mL had a median OS of 36 months and RFS of 12 months, and patients with IBL ≤250 mL had a median OS of 36 months and RFS of 24 months.

Conclusions: We found that the extent of IBL during LH was related to tumor size, operative time, and surgery type. Increased IBL during LH was also an independent prognostic factor for tumor recurrence. Furthermore, a dose-response relationship between increased IBL and decreased RFS and OS was evident.