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:
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.
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
Research background

Epidural analgesia is a well-known technique use in thoracic and abdominal surgery for its benefits in stress response, pulmonary complications. Anesthesiologists are afraid of its use in patients with potentially haemostatics disorders. Liver surgery is an example of them. In literature is well described the use of epidural analgesia in hepatic surgery and others, with different opinions. So that, we wanted to study the behaviour haemostatic profile after a particular etiology of hepatic resection, colon-rectum liver metastases. We think are patients with particular peculiarities in liver function non comparable to others disease, thus the use of epidural analgesia could be safer than in others, with greater benefits than risks.

Research motivation

Patient wellness, patient comfort, patient care, minimize patient stress previous and following days after surgery is one of the goals for all health professionals. So that, in literature is well published the benefits of epidural analgesia in many patients under thoracic or abdominal surgeries. Is for that we started this study, because of the discrepancies existing in use or not use epidural techniques in patients under liver surgery with potentially haemostatic postoperative disorders.

Research objectives

To know the behaviour of haemostatic profile following a colon-rectum metastases liver resection, to considerer if benefits of epidural analgesia are greater than risks.

Research methods

The research methods (e.g., experiments, data analysis, surveys, and clinical trials) that were adopted to realize the objectives, as well as the characteristics and novelty of these research methods, should be described in detail.

Research results

We found in both minor and major hepatic resections, there was oscillation in international normalized ratio (INR) and prothrombin time till 48th postoperative hours. These variations in minor resections were never greater than INR 1.5, instead in major resections existed at 48th postoperative hours haemostatic alteration that turn to normal range before postoperative day 5. We did not use fresh frozen plasma or prothrombin complex to improve the haemostasia prior to remove an epidural catheter.

Research conclusions

Haemostatic profile following colon-rectum hepatic metastases resection. Safety use an epidural catheter in patients under colon-rectum liver metastases resection. Benefits of epidural analgesia for patients under colon-rectum metastases liver resections are greater than risks, but if you chose use it, use it with care. Offer to anaesthesiologists another tool in anesthesia and analgesia management in patients with those characteristics.

Research perspectives

Never is enough when in terms of health recommendations is worked. More studies are always necessary to improve and certified your studies.