PERIOPERATIVE BLOOD-TRANSFUSION PROMOTES RECURRENCE OF HEPATOCELLULAR-CARCINOMA AFTER HEPATECTOMY

Background. Recent advances in liver surgery have reduced operative blood loss drastically, and in more than one half of the patients in our hospital, the liver resection can be accomplished without blood transfusion. Methods. Two hundred fifty-two patients who underwent complete resection for hepatocellular caracinoma (HCC) were evaluated to assess the effect of perioperative blood transfusion on the recurrence of carcinoma. Results. Carcinoma recurred in 55 (74.3%) of the 74 patients who received a transfusion, but in only 89 (50%) of the 178 patients who did not receive a transfusion (p = 0.0001). This effect was significant even when only a small amount of blood was transfused (p = 0.0001). Based on multivariate analysis, perioperative blood transfusion was a significant predictor for accelerated recurrence (p = 0.003), as were tumor invasiveness (vascular invasion or intrahepatic metatasis) (p = 0.0008) and background liver cirrhosis (p = 0.04). The recurrence-promoting effect of blood transfusion was markedly significant when the patients had either noninvasive HCC (p = 0.0005) or a cirrhotic liver (p < 0.0001). Conclusions. These results strongly suggest that perioperative blood transfusion substantially promotes the recurrence of HCC after hepatectomy. This effect must be considered and added to the risks of perioperative blood transfusion when formulating a surgical strategy for HCC.