Clinical Research Of The Influence Of Preoperative Anemia On Postoperative Recovery Of Patients Undergoing Laparoscopic Hepatectomy

Background:With the rapid development of laparoscopic hepatectomy in recent years and the emergence of various new concepts and technologies,hepatectomy is developing towards a safer,more minimally invasive and more standardized direction.On this basis,the amount of blood loss during hepatectomy was significantly reduced compared with that before,and zero blood transfusion has become the norm to complete the operation.However,due to the fact that the liver parenchyma is filled with hepatic sinuses,hepatic arteries,hepatic veins,portal veins,intrahepatic bile ducts and other important pipelines,and the inferior vena cava is adjacent,hepatectomy is still one of the most difficult operations in abdominal surgery,and preoperative blood preparation is one of the necessary procedures to ensure the smooth operation.However,in recent years,with the outbreak of COVID-19,the impact of blood shortage on surgical operations has become increasingly obvious.During the severe epidemic period,even blood is only for rescue,which can not guarantee the situation of blood preparation for surgery.It is a difficult choice to continue or postpone the operation.Especially for patients with liver malignant tumors who need a deadline for surgery,the delay undoubtedly increases the risk of tumor growth and even metastasis.During this period,our center has successfully completed several laparoscopic hepatectomy operations for some small liver cancer,metastatic tumor,benign tumor and other relatively simple cases without blood transfusion after full preoperative evaluation and preparation of operation plan.Therefore,laparoscopic hepatectomy has become a conventional operation with mature technology at this stage.We should discuss and study the influence of preoperative anemia on postoperative recovery of patients undergoing laparoscopic hepatectomy again,so as to give effective suggestions for perioperative management of patients undergoing laparoscopic hepatectomy and anemia.Methods:The data of 237 patients undergoing laparoscopic hepatectomy in our center is analyzed retrospectively.Through the matching of propensity score,23 cases of anemia and 85 cases of non-anemia were selected.The baseline data is balanced.The differences between the two groups of postoperative data were analyzed.Logistic regression was used to analyze the risk factors of postoperative hypoproteinemia and anemia,and ROC curve was used to verify the effectiveness of the model.Result:The hemoglobin of the patients in the anemia group on the 1st,3rd and 5th day after operation was lower than that of the patients in the non-anemia group,and the difference was statistically significant[107.00(95.00,115.00)vs.130.00(122.00,139.50),P<0.001;96.00(88.00,107.00)vs.121.00(111.00,130.00),P<0.001;95.00(88.00,108.00)vs.119.00(110.00,130.00),P<0.001].The serum albumin of the patients in the anemia group was lower than that of the patients in the non-anemia group on the first day after operation,and the difference was statistically significant[32.90(30.00,33.90)vs.34.00(31.80,36.30),P=0.015].The lower the preoperative BMI value and preoperative ALB value,the higher the risk of hypoproteinemia on the first day after operation,with statistical significance(OR=0.785,95%CI 0.711-0.867,P<0.001),AUC=0.731(95CI 0.668-0.795,P<0.001).The lower the preoperative HGB value,the higher the risk of anemia on the 5th day after operation,with statistical significance(OR=0.925,95%CI 0.901-0.950,P<0.001),AUC=0.773(95%CI 0.715-0.832,P<0.001).Conclusion:The influence of preoperative anemia on postoperative recovery of patients undergoing laparoscopic hepatectomy lies in hemoglobin and albumin,while the other indexes have no significant effect on postoperative hospitalization.There was no difference in the recovery of albumin between the two groups after receiving postoperative nutritional support.Therefore,it is safe and feasible for anemia patients(Hb≥85g/L)to undergo laparoscopic hepatectomy,and there is no obvious impact on postoperative recovery.However,it is necessary to pay attention to the management of hemoglobin and albumin during the perioperative period,and timely apply targeted treatment to promote postoperative recovery.