Prospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Sep 6, 2019; 7(17): 2477-2486
Published online Sep 6, 2019. doi: 10.12998/wjcc.v7.i17.2477
Analysis of the postoperative hemostatic profile of colorectal cancer patients subjected to liver metastasis resection surgery
Guillermo Perez Navarro, Ana Maria Pascual Bellosta, Sonia María Ortega Lucea, Mario Serradilla Martín, Jose Manuel Ramirez Rodriguez, Javier Martinez Ubieto
Guillermo Perez Navarro, Ana Maria Pascual Bellosta, Sonia María Ortega Lucea, Javier Martinez Ubieto, Department of Anesthesiology, University Hospital Miguel Servet, Zaragoza 50009, Spain
Mario Serradilla Martín, Department of General Surgery, University Hospital Miguel Servet, Zaragoza 50009, Spain
Jose Manuel Ramirez Rodriguez, Department of General Surgery, University Hospital Lozano Blesa, Zaragoza 50009, Spain
Author contributions: Each author has participated sufficiently in the work to take public responsibility for appropriate portions of the content. Perez Navarro G and Pascual Bellosta AM contributed equally to this work, Ortega Lucea SM wrote the paper; Martinez Ubieto J designed the study and research; Serradilla Martín SMM and Ramirez Rodriguez JM performed research.
Institutional review board statement: The study was reviewed and approved by the Investigation and Innovation Committee at University Hospital Miguel Servet of Zaragoza (Spain).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous date that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: There is no conflict of interest on the part of any author
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/
Corresponding author: Ana Maria Pascual Bellosta, MD, PhD, Doctor, Department of Anesthesiology, University Hospital Miguel Servet, P Paseo Isabel La Católica 1-3, Zaragoza 50009, Spain. anapascual689@gmail.com
Telephone: +34-67-5565916 Fax: +34-97-6765500
Received: April 6, 2019
Peer-review started: April 8, 2019
First decision: June 28, 2019
Revised: July 23, 2019
Accepted: July 27, 2019
Article in press: July 27, 2019
Published online: September 6, 2019
Abstract
BACKGROUND

Liver resection surgery has advanced greatly in recent years, and the adoption of fasttrack programs has yielded good results. Combination anesthesia (general anesthesia associated to epidural analgesia) is an anesthetic-analgesic strategy commonly used for the perioperative management of patients undergoing surgery of this kind, though there is controversy regarding the coagulation alterations it may cause and which can favor the development of spinal hematomas.

AIM

To study the postoperative course of liver resection surgery, an analysis was made of the outcomes of liver resection surgery due to colorectal cancer metastases in our centre in terms of morbiditymortality and hospital stay according to the anesthetic technique used (general vs combination anesthesia).

METHODS

A prospective study was made of 61 colorectal cancer patients undergoing surgery due to liver metastases under general and combination anesthesia between January 2014 and October 2015. The patient characteristics, intraoperative variables, postoperative complications, evolution of hemostatic parameters, and stay in intensive care and in hospital were analyzed.

RESULTS

A total of 61 patients were included in two homogeneous groups: general anesthesia (n = 30) and combination anesthesia (general anesthesia associated to epidural analgesia) (n = 31). All patients had normal coagulation values before surgery. The international normalized ratio (INR) in both the general and combination anesthesia groups reached maximum values at 2448 h (mean 1.37 and 1.45 vs 1.39 and 1.41, respectively), followed by a gradual decrease. There was less intraoperative bleeding in the combination anesthesia group (769 mL) than in the general anesthesia group (1200 mL) (P < 0.05). Of the 61 patients, 38.8% in the general anesthesia group experienced some respiratory complication vs 6.6% in the combination anesthesia group (P < 0.001). The time to gastrointestinal tolerance was significantly correlated to the type of anesthesia, though not so the stay in critical care or the time to hospital discharge.

CONCLUSION

Epidural analgesia in liver resection surgery was seen to be safe, with good results in terms of pain control and respiratory complications, and with no associated increase in complications secondary to altered hemostasis.

Keywords: Hepatectomy, Epidural analgesia, Perioperative complications, Epidural hematoma, Multimodal rehabilitation, Outcomes

Core tip: This is a study of morbiditymortality and hospital stay according to the anesthetic technique used (general vs combination anesthesia) in liver resection surgery in patients with colorectal cancer metastases. Epidural analgesia in liver resection surgery was seen to be safe, with good results in terms of pain control and respiratory complications, and with no associated increase in complications secondary to altered hemostasis. The time to gastrointestinal tolerance was significantly correlated to the type of anesthesia, though not so the stay in critical care or the time to hospital discharge.