Retrospective Cohort Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Aug 16, 2017; 9(8): 396-404
Published online Aug 16, 2017. doi: 10.4253/wjge.v9.i8.396
Impact of laparoscopic liver resection on bleeding complications in patients receiving antithrombotics
Takahisa Fujikawa, Hiroshi Kawamoto, Yuichiro Kawamura, Norio Emoto, Yusuke Sakamoto, Akira Tanaka
Takahisa Fujikawa, Hiroshi Kawamoto, Yuichiro Kawamura, Norio Emoto, Yusuke Sakamoto, Akira Tanaka, Department of Surgery, Kokura Memorial Hospital, Fukuoka 802-8555, Japan
Author contributions: Fujikawa T designed and performed research, and analyzed data; Fujikawa T prepared a manuscript; Kawamoto H, Kawamura Y, Emoto N, Sakamoto Y and Tanaka A reviewed it.
Institutional review board statement: The study was reviewed and approved for publication by our Institutional Review Board.
Informed consent statement: Patients were not required to give informed concent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: The authors report no relevant conflicts of interest.
Data sharing statement: No additional data are available. Collected data under the form of Excel tables will be available on request. The authors are not responsible of any concern issued from external use of these files.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Takahisa Fujikawa, MD, PhD, Director, Department of Surgery, Kokura Memorial Hospital, 3-2-1 Asano, Kokurakita-ku, Kitakyushu, Fukuoka 802-8555, Japan. fujikawa-t@kokurakinen.or.jp
Telephone: +81-93-5112000 Fax: +81-93-5113240
Received: January 26, 2017
Peer-review started: February 8, 2017
First decision: May 10, 2017
Revised: May 19, 2017
Accepted: May 30, 2017
Article in press: May 31, 2017
Published online: August 16, 2017
Abstract
AIM

To assess the impact of laparoscopic liver resection (LLR) on surgical blood loss (SBL), especially in patients with antithrombotics for thromboembolic risks.

METHODS

Consecutive 258 patients receiving liver resection at our institution between 2010 and 2016 were retrospectively reviewed. Preoperative antithrombotic therapy (ATT; antiplatelets and/or anticoagulation) was regularly used in 100 patients (ATT group, 38.8%) whereas not used in 158 (non-ATT group, 61.2%). Our perioperative management of high thromboembolic risk patients included maintenance of preoperative aspirin monotherapy for patients with antiplatelet therapy and bridging heparin for patients with anticoagulation. In both ATT and non-ATT groups, outcome variables of patients undergoing LLR were compared with those of patients receiving open liver resection (OLR), and the independent risk factors for increased SBL were determined by multivariate analysis.

RESULTS

This series included 77 LLR and 181 OLR. There were 3 thromboembolic events (1.2%) in a whole cohort, whereas increased SBL (≥ 500 mL) and postoperative bleeding complications (BCs) occurred in 66 patients (25.6%) and 8 (3.1%), respectively. Both in the ATT and non-ATT groups, LLR was significantly related to reduced SBL and low incidence of BCs, although LLR was less performed as anatomical resection. Multivariate analysis showed that anatomical liver resection was the most significant risk factor for increased SBL [risk ratio (RR) = 6.54, P < 0.001] in the whole cohort, and LLR also had the significant negative impact (RR = 1/10.0, P < 0.001). The same effects of anatomical resection (RR = 15.77, P < 0.001) and LLR (RR = 1/5.88, P = 0.019) were observed when analyzing the patients in the ATT group.

CONCLUSION

LLR using the two-surgeon technique is feasible and safely performed even in the ATT-burdened patients with thromboembolic risks. Independent from the extent of liver resection, LLR is significantly associated with reduced SBL, both in the ATT and non-ATT groups.

Keywords: Laparoscopic liver resection, Two-surgeon technique, Antithrombotic therapy, Increased surgical blood loss, Bleeding complication

Core tip: Analyzing consecutive 258 patients undergoing liver resection using the two-surgeon technique, we showed that laparoscopic liver resection is significantly associated with reduced surgical blood loss and low postoperative bleeding complications even in antithrombotic-burdened patients with thromboembolic risks.