Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Dec;51(12):1953-1968.
doi: 10.1007/s00595-021-02314-5. Epub 2021 Jun 15.

Relationship between hepatic venous anatomy and hepatic venous blood loss during hepatectomy

Atsushi Nanashima  1   2 , Yukinori Tanoue  3   4 , Tatefumi Sakae  5 , Isao Tsuneyoshi  6 , Masahide Hiyoshi  3 , Naoya Imamura  3 , Takeomi Hamada  3 , Koichi Yano  3 , Takahiro Nishida  3 , Mitsutoshi Ishii  3   4 , Takeshi Nagayasu  4 , Kunihide Nakamura  3
Affiliations

Relationship between hepatic venous anatomy and hepatic venous blood loss during hepatectomy

Atsushi Nanashima et al. Surg Today. 2021 Dec.

Abstract

Purpose: Predicting increased blood loss based on anatomical intervascular relationships is essential in major hepatectomy.

Methods: We assessed 63 consecutive patients undergoing anatomical hepatectomy exposing the hepatic vein (HV) trunk at two institutes. Correlations between anatomical alterations of the hepatic inferior vena cava (IVC), HV, hepatic IVC, or right atrium (RA) and the blood loss per standard weight (BLSW) or blood transfusion (n = 18) were analyzed. The results of IVC partial clamping (PC) were additionally examined.

Results: The BLSW in type V-up anatomical morphology was significantly higher than that in straight type (p < 0.05). The parameters associated with an increased BLSW (> 13.5 mL/kg) were tumor size (> 4 cm), prothrombin activity (< 87%), CVP (> 7 mmHg), area of suprahepatic IVC (< 360 mm2), IVC-RA gap (> 28 mm), longitudinal angle of IVC (< 160°), and axial angle of the MHV (< 55°). A multivariate analysis revealed that a high IVC-RA gap was a significant independent risk factor (odds ratio; 4.32, p < 0.05). Among 25 patients undergoing IVC-PC, only three showed a remarkable decrease in hepatic venous bleeding. No other statistically significant differences in the surgical records were observed in most cases.

Conclusion: The IVC-RA gap might be a promising novel predictive parameter reflecting increased blood loss leading to blood transfusion in anatomical hepatectomy.

Keywords: Blood loss; Hepatectomy; IVC clamp; Vascular anatomy; Venous pressure.

PubMed Disclaimer

Similar articles

See all similar articles

Cited by

References

    1. Moris D, Tsilimigras DI, Kostakis ID, Ntanasis-Stathopoulos I, Shah KN, Felekouras E, et al. Anatomic versus non-anatomic resection for hepatocellular carcinoma: a systematic review and meta-analysis. Eur J Surg Oncol. 2018;44:927–38. - PubMed
    1. Shindoh J, Tzeng CW, Aloia TA, Curley SA, Huang SY, Mahvash A, et al. Safety and efficacy of portal vein embolization before planned major or extended hepatectomy: an institutional experience of 358 patients. J Gastrointest Surg. 2014;18:45–51. - PubMed
    1. Walcott-Sapp S, Billingsley KG. Preoperative optimization for major hepatic resection. Langenbecks Arch Surg. 2018;403:23–35. - PubMed
    1. Kokudo N, Takemura N, Ito K, Mihara F. The history of liver surgery: achievements over the past 50 years. Ann Gastroenterol Surg. 2020;4:109–17. - PubMed - PMC
    1. Fuchs J, Warmann SW, Szavay P, Kirschner HJ, Schäfer JF, Hennemuth A, et al. Three-dimensional visualization and virtual simulation of resections in pediatric solid tumors. J Pediatr Surg. 2005;40:364–70. - PubMed

LinkOut - more resources