Impact of laparoscopic liver resection on bleeding complications in patients receiving antithrombotics

Table 1 Background characteristics of patients in the cohort n (%)

Variables	Total (n = 258)	ATT (n = 100)			Non-ATT (n = 158)
		LLR (n = 35)	OLR (n = 65)	P value	LLR (n = 42)	OLR (n = 116)	P value
Age, yr, median (range)	69 (36-89)	78 (59-90)	76 (52-92)	0.067	71 (45-89)	69 (36-86)	0.106
Gender				0.312			1
Female	80 (31.0)	10 (28.6)	12 (18.5)		15 (35.7)	43 (37.1)
Male	178 (69.0)	25 (71.4)	53 (81.6)		27 (64.3)	73 (62.9)
BMI				0.662			1
< 30 kg/m2	247 (95.7)	34 (97.1)	60 (92.3)		41 (97.6)	112 (96.6)
≥ 30 kg/m2	11 (4.3)	1 (2.9)	5 (7.7)		1 (2.4)	4 (3.4)
Performance status				0.124			1
0, 1	242 (93.8)	30 (85.7)	62 (95.4)		40 (95.2)	110 (94.8)
2, 3	16 (6.2)	5 (14.3)	3 (4.6)		2 (4.8)	6 (5.2)
Concurrent diseases
Diabetes mellitus	58 (22.5)	10 (28.6)	17 (26.2)	0.817	7 (16.7)	24 (20.7)	0.656
Hx of congestive heart failure	21 (8.1)	8 (22.9)	11 (16.9)	0.594	1 (2.4)	1 (0.9)	0.462
Coronary artery disease
Hx of PCI	49 (19.0)	17 (48.6)	31 (47.7)	1	1 (2.4)	0 (0.0)	0.266
Hx of CABG	7 (2.7)	4 (11.4)	3 (4.6)	0.236	0 (0.0)	0 (0.0)	-
Hx of cerebral infarction	26 (10.1)	5 (14.3)	17 (26.2)	0.212	0 (0.0)	4 (3.4)	0.574
Current hemo-/peritoneal dialysis	11 (4.3)	2 (5.7)	5 (7.7)	1	1 (2.4)	3 (2.6)	1
Anticoagulation therapy	30 (11.6)	8 (22.9)	22 (33.8)	0.360	-	-	-
Periop. heparin bridging	26 (10.1)	7 (20.0)	19 (29.2)	0.350	-	-	-
Preop. aspirin continuation	35 (13.6)	14 (40.0)	21 (32.3)	0.382	-	-	-

ATT: Antithrombotic therapy; LLR: Laparoscopic liver resection; OLR: Open liver resection; BMI: Body mass index; PCI: Percutaneous coronary intervention; CABG: Coronary artery bypass graft; periop.: Perioperative; preop.: Preoperative.

Table 2 Factors concerning operative procedures and postoperative morbidity n (%)

Variables	Total (n = 258)	ATT (n = 100)			Non-ATT (n = 158)
		LLR (n = 35)	OLR (n = 65)	P value	LLR (n = 42)	OLR (n = 116)	P value
Liver diseases				0.393			0.271
HCC	97 (37.6)	15 (42.9)	22 (33.8)		19 (45.2)	41 (35.3)
Non HCC	161 (62.4)	20 (57.1)	43 (66.2)		23 (54.8)	75 (64.7)
Type of operation				< 0.001			0.004
Partial resection	163 (63.2)	24 (68.6)	38 (58.5)		31 (73.8)	70 (60.3)
Sub-sectionectomy (S5, 6, 8)	9 (3.5)	0 (0.0)	2 (3.1)		4 (9.5)	3 (2.6)
Lateral sectionectomy	19 (7.4)	9 (25.7)	1 (1.5)		4 (9.5)	5 (4.3)
Other anatomical hepatectomy	67 (26.0)	2 (5.7)	24 (36.9)		3 (7.1)	38 (32.8)
Duration of ope., min, median (range)	230 (74-705)	198 (98-418)	257 (86-587)	0.011	204 (104-420)	242 (74-705)	0.049
Surgical blood loss, mL, median (range)	200 (1-11070)	80 (1-850)	310 (5-2100)	< 0.001	50 (1-530)	265 (2-11070)	0.007
Intraoperative RBC transfusion	45 (17.4)	4 (11.4)	12 (18.5)	0.408	3 (7.1)	26 (22.4)	0.035
Postop. complication
None	217 (84.1)	34 (97.1)	50 (76.9)	0.009	41 (97.6)	92 (79.3)	0.005
Superficial SSI	8 (3.1)	0 (0.0)	2 (3.1)		1 (2.4)	7 (6.0)
Deep SSI	5 (1.9)	0 (0.0)	3 (4.6)		0 (0.0)	2 (1.7)
Bile leakage	11 (4.3)	0 (0.0)	4 (6.2)		0 (0.0)	7 (6.0)
Bleeding complication	8 (3.1)	0 (0.0)	3 (4.6)		0 (0.0)	5 (4.3)
Major bleeding	6 (2.3)	0 (0.0)	3 (4.6)		0 (0.0)	3 (2.6)
Minor bleeding	2 (0.8)	0 (0.0)	0 (0.0)		0 (0.0)	2 (1.7)
Thromboembolic complication	3 (1.2)	0 (0.0)	1 (1.5)		0 (0.0)	2 (1.7)
Cerebral infarction	2 (0.8)	0 (0.0)	0 (0.0)		0 (0.0)	2 (1.7)
Coronary stent thrombosis	1 (0.4)	0 (0.0)	1 (1.5)		0 (0.0)	0 (0.0)
Cardiopulmonary arrest	1 (0.4)	1 (2.9)	0 (0.0)		0 (0.0)	0 (0.0)
Operative mortality	1 (0.4)	1 (2.9)	0 (0.0)	0.350	0 (0.0)	0 (0.0)	-
Length of postop. stay, d, median (range)	14 (4-103)	12 (7-23)	15 (8-103)	0.174	11 (6-19)	15 (4-92)	0.321

ATT: Antithrombotic therapy; LLR: Laparoscopic liver resection; OLR: Open liver resection; HCC: Hepatocellular carcinoma; RBC: Red blood cell; ope.: Operation; postop.; Postoperative; SSI: Surgical site infection.

Table 3 Univariate analysis of increased surgical blood loss (≥ 500 mL) in the whole cohort (n = 258) and in the antithrombotic therapy group (n = 100, %)

Variables	Increased surgical blood loss (≥ 500 mL)
	The whole cohort (n = 258)		ATT group (n = 100)
	Present/total	P value	Present/total	P value
Total	66/258 (25.6)		23/100 (23.0)
Age		0.664		0.811
≥ 75 yr	25/105 (23.8)		14/57 (24.6)
< 75 yr	41/153 (26.8)		9/43 (20.9)
Gender		0.009		0.389
Female	12/80 (15.0)		3/22 (13.6)
Male	54/178 (30.3)		20/78 (25.6)
BMI		0.734		0.332
< 30 kg/m2	64/247 (25.9)		23/94 (24.5)
≥ 30 kg/m2	2/11 (18.2)		0/6 (0.0)
Performance status		1		0.192
0, 1	62/242 (25.6)		23/92 (25.0)
2-4	4/16 (25.0)		0/8 (0.0)
ASA class		0.148		0.789
I, II	34/153 (22.2)		5/25 (20.0)
III, IV	32/105 (30.5)		18/75 (24.0)
Diabetes mellitus		0.733		1
Yes	16/58 (27.6)		6/27 (22.2)
No	50/200 (25.0)		17/73 (23.3)
Hx of PCI		0.589		0.234
Yes	14/49 (28.6)		14/48 (29.2)
No	52/209 (24.9)		9/52 (17.3)
ATT used		0.468		-
Yes	23/100 (23.0)		-
No	43/158 (27.2)		-
Multiple APT used		0.117		0.035
Yes	11/29 (37.9)		11/29 (37.9)
No	55/229 (24.0)		12/71 (16.9)
Preop. aspirin continuation		0.215		0.046
Yes	12/35 (34.3)		12/34 (35.3)
No	54/223 (24.2)		11/66 (16.7)
Liver diseases		0.008		0.138
HCC	34/97 (35.1)		12/37 (32.4)
Non HCC	32/161 (19.9)		11/63 (17.5)
Laparoscopic liver resection		< 0.001		0.013
Yes	4/77 (5.2)		3/35 (8.6)
No	62/181 (34.3)		20/65 (30.8)
Anatomical liver resection		< 0.001		< 0.001
Yes	46/95 (48.4)		19/38 (50.0)
No	20/163 (12.3)		4/62 (6.5)

ATT: Antithrombotic therapy; BMI: Body mass index; ASA: American Society of Anesthesiologists; PCI: Percutaneous coronary intervention; APT: Antiplatelet therapy; HCC: Hepatocellular carcinoma; Preop.: Preoperative.