OBJECTIVE To reappraise whether preoperative autologous blood donation reduces post-hepatectomy liver failure (PHLF) in major hepatectomy for perihilar malignancy. SUMMARY BACKGROUND DATA Autologous blood storage and transfusion are carried out to reduce the use of allogeneic blood transfusion during hepatectomy and prevent postoperative complications. However, the clinical benefit in major hepatectomy has been controversial. METHODS This randomized clinical trial included patients who underwent major hepatectomy with extrahepatic bile duct resection for perihilar malignancy. Eligible patients were randomly assigned (1:1) to undergo surgery with or without the use of autologous blood transfusion. The primary outcome was the incidence of clinically relevant PHLF (grade B/C according to the International Study Group of Liver Surgery definition). RESULTS Between February 6, 2019, and May 12, 2023, 138 consecutive patients were enrolled in the study (blood storage group n=68, non-storage group n=70). Twenty-five patients who did not undergo resection were excluded; the remaining 113 patients were investigated as the full analysis set (blood storage group n=60, non-storage group n=53). Surgical procedures, operative time, and blood loss were not significantly different between the two groups. The incidence of PHLF was comparable (blood storage group n=10 [17%], non-storage group n=10 [19%]; P=0.760). There were also no between-group differences in other postoperative outcomes, including the incidence of Clavien-Dindo Grade Ⅲ or higher (72% vs. 72%, P=0.997) and median duration of hospital stay (25 vs. 29 d, P=0.277). CONCLUSIONS Autologous blood storage did not contribute to reducing the incidence of PHLF in patients undergoing major hepatectomy.

中文翻译：

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术前自体血液储存对肝门周围恶性肿瘤主要肝切除术的影响：一项随机对照试验。


目的 重新评估术前自体献血是否可以减少肝门周围恶性肿瘤肝切除术后肝功能衰竭 (PHLF)。背景资料自体血储存和输血是为了减少肝切除术中同种异体输血的使用，预防术后并发症。然而，主要肝切除术的临床益处一直存在争议。方法 这项随机临床试验纳入了因肝门周围恶性肿瘤而接受主要肝切除术和肝外胆管切除术的患者。符合条件的患者被随机分配（1:1）接受使用或不使用自体输血的手术。主要结局是临床相关 PHLF 的发生率（根据国际肝脏手术研究组的定义，B/C 级）。结果 2019年2月6日至2023年5月12日期间，连续138名患者入组研究（储血组n=68，非储存组n=70）。排除了 25 名未接受切除术的患者；其余113名患者作为完整分析集进行调查（血液储存组n = 60，非储存组n = 53）。两组之间的手术程序、手术时间和失血量没有显着差异。 PHLF 的发生率具有可比性（储血组 n=10 [17%]，非储存组 n=10 [19%]；P=0.760）。其他术后结局也没有组间差异，包括 Clavien-Dindo Ⅲ级或以上的发生率（72% vs. 72%，P=0.997）和中位住院时间（25 vs. 29 d，P） =0.277）。结论 自体血液储存无助于降低接受主要肝切除术的患者 PHLF 的发生率。