DISSEMINATED INTRAVASCULAR COAGULATION SYNDROME IN SURGICAL TREATMENT OF PATIENTS WITH LIVER MALIGNANCIES

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Abstract

Rationale: Extended resections or extended lobectomies are the most common types of surgical interventions in patients with liver malignancies, and they are associated with serious post-operative complications. Aim: To characterize the role of hemostasis abnormalities in the pathophysiology of post-operative hepatic insufficiency, as well as that of thrombotic and hemorrhagic complications in patients with liver malignancies. Materials and methods: One hundred and twenty patients with liver malignancies were recruited into the study (20  patients with primary hepatic tumors and 100  with colorectal cancer and liver metastases). Extended liver resections (right and left simple and extended lobectomies, both simple and extended) were performed in 100  (84%) of patients; multi-segmental liver resections, in 20  (16%). Assessment of hemostasis was done pre-operatively and at days 1  to 20  after surgery (hemostasis analyzer system STA-R Evolution and Chrono-log aggregometer). Results: After surgical intervention in the liver, subacute disseminated intravascular coagulation (DIC) was found in 34 patients. It was most common (65%) after the right lobectomy and was associated with a  decrease in fibrinogen levels to 121 mg/dL (p<0.01), prothrombin complex factors, to 45%  (р<0.05), antithrombin III to 48%  (р<0.05), with a  significant increase in D dimmer levels of up to 14.5 mcg/mL (р<0.05). Twelve patients with subacute DIC developed deep venous thrombosis of the lower extremities, and 9  patients had severe hepatic insufficiency. Patients with severe hepatic insufficiency had a  statistically significant decrease in prothrombin activity to 45%  (p<0.05), antithrombin III to 44%, plasminogen<50%, with high D dimer (>20  mcl/mL) and von Willebrand factor levels. Conclusion: Surgical interventions in patients with liver malignancy may lead to the development of DIC. Early diagnosis and correction of hemostasis-related risk factors of hepatic insufficiency allows for improvement of the results of surgery in patients with secondary hepatic malignancies.

About the authors

O. V. Somonova

N.N. Blokhin Russian Cancer Research Center; 24 Kashirskoe shosse, Moscow, 115478, Russian Federation

Author for correspondence.
Email: somonova@mail.ru
MD, PhD, Leading Research Fellow, Clinical Diagnostic Laboratory Russian Federation

A. L. Elizarova

N.N. Blokhin Russian Cancer Research Center; 24 Kashirskoe shosse, Moscow, 115478, Russian Federation

Email: somonova@mail.ru
PhD (in Biol.), Senior Research Fellow, Clinical Diagnostic Laboratory Russian Federation

I. I. Matveeva

N.N. Blokhin Russian Cancer Research Center; 24 Kashirskoe shosse, Moscow, 115478, Russian Federation

Email: somonova@mail.ru
MD, PhD, Head of Clinical Diagnostic Laboratory Russian Federation

References

  1. Патютко ЮИ, Котельников АГ, Мамонтов КГ, Пономаренко АА, Лазарев АФ. Непосредственные результаты резекций печени по поводу метастазов колоректального рака. Онкологическая колопроктология. 2014;(1):14–20.
  2. Патютко ЮИ, Сагайдак ИВ, Котельников АГ, Поляков АН, Чучуев ЕС, Пылев АЛ, Чистякова ОВ, Шишкина НА. Резекция печени: современные технологии при опухолевом поражении. Анналы хирургической гепатологии. 2010;15(2):9–17.
  3. Kanas GP, Taylor A, Primrose JN, Langeberg WJ, Kelsh MA, Mowat FS, Alexander DD, Choti MA, Poston G. Survival after liver resection in metastatic colorectal cancer: review and meta-analysis of prognostic factors. Clin Epidemiol. 2012;4:283–301. doi: 10.2147/CLEP.S34285.
  4. Патютко ЮИ, Пылев АЛ, Сагайдак ИВ, Ко-тельников АГ, Подлужный ДВ, Поляков АН, Абгарян МГ, Чучуев ЕС, Гахраманов АД, Шишкина НА, Агафонова МГ. Десятилетняя выживаемость больных злокачественными опухолями печени после хирургического лечения. Анналы хирургической гепатологии. 2010;15(3):39–47.
  5. Чиссов ВИ, Бутенко АВ, Вашакмадзе ЛА, Сидоров ДВ, Гришин НА, Ложкин МВ, Степанов СО, Хомяков ВМ, Швейкин АО, Гуц ОВ. Хирургическое лечение первичного и метастатического рака печени. Российский онкологический журнал. 2010;(5):8–12.
  6. Sato T, Yasui A, Kondo S, Kato M, Kameoka N, Nimura Y. Changes in liver blood flow after hepatectomy in conscious dogs. Surg Today. 1996;26(9):688–93.
  7. Sato Y, Koyama S, Tsukada K, Hatakeyama K. Acute portal hypertension reflecting shear stress as a trigger of liver regeneration following partial hepatectomy. Surg Today. 1997;27(6):518–26.
  8. Kin Y, Nimura Y, Hayakawa N, Kamiya J, Kon-do S, Nagino M, Miyachi M, Kanai M. Doppler analysis of hepatic blood flow predicts liver dysfunction after major hepatectomy. World J Surg. 1994;18(1):143–9.
  9. Huang ZQ, Xu LN, Yang T, Zhang WZ, Huang XQ, Cai SW, Zhang AQ, Feng YQ, Zhou NX, Dong JH. Hepatic resection: an analysis of the impact of operative and perioperative factors on morbidity and mortality rates in 2008 consecutive hepatectomy cases. Chin Med J (Engl). 2009;122(19):2268–77.
  10. Вишневский ВА, Кубышкин ВА, Чжао АВ, Икрамов РЗ. Операции на печени. М.: Миклош; 2003. 157 с.
  11. Патютко ЮИ. Хирургическое лечение злокачественных опухолей печени. М.: Практическая медицина; 2005. 312 c.
  12. Jarnagin WR, Gonen M, Fong Y, DeMatteo RP, Ben-Porat L, Little S, Corvera C, Weber S, Blumgart LH. Improvement in perioperative outcome after hepatic resection: analysis of 1,803 consecutive cases over the past decade. Ann Surg. 2002;236(4):397–406. doi: 10.1097/01.SLA.0000029003.66466.B3.
  13. Герок В, Блюм ХЕ. Заболевания печени и желчевыводящей системы. Пер. с нем. М.: МЕДпресс-информ; 2009. 200 с.
  14. Balzan S, Belghiti J, Farges O, Ogata S, Sauvanet A, Delefosse D, Durand F. The "50-50 criteria" on postoperative day 5: an accurate predictor of liver failure and death after hepatectomy. Ann Surg. 2005;242(6):824–8. doi: 10.1097/01.sla.0000189131.90876.9e.
  15. van den Broek MA, Olde Damink SW, Dejong CH, Lang H, Malagó M, Jalan R, Saner FH. Liver failure after partial hepatic resection: definition, pathophysiology, risk factors and treatment. Liver Int. 2008;28(6):767–80. doi: 10.1111/j.1478-3231.2008.01777.x.
  16. Meijer C, Wiezer MJ, Hack CE, Boelens PG, Wedel NI, Meijer S, Nijveldt RJ, Statius Muller MG, Wiggers T, Zoetmulder FA, Borel Rinkes IH, Cuesta MA, Gouma DJ, van de Velde CJ, Tilanus HW, Scotté M, Thijs LG, van Leeu-wen PA. Coagulopathy following major liver resection: the effect of rBPI21 and the role of decreased synthesis of regulating proteins by the liver. Shock. 2001;15(4):261–71.
  17. Amin C, Mackman N, Key NS. Microparticles and cancer. Pathophysiol Haemost Thromb. 2008;36(3–4):177–83. doi: 10.1159/000175155.
  18. Magnus N, D'Asti E, Meehan B, Garnier D, Rak J. Oncogenes and the coagulation system – forces that modulate dormant and aggressive states in cancer. Thromb Res. 2014;133 Suppl 2:S1–9. doi: 10.1016/S0049-3848(14)50001-1.
  19. Umemura Y, Yamakawa K, Kiguchi T, Yoshikawa Y, Ogura H, Shimazu T, Hamasaki T, Fujimi S. Design and evaluation of New Unified Criteria for Disseminated Intravascular Coagulation based on the Japanese Association for Acute Medicine Criteria. Clin Appl Thromb Hemost. 2016;22(2):153–60. doi: 10.1177/1076029615591169.
  20. Wada H, Matsumoto T, Yamashita Y. Diagnosis and treatment of disseminated intravascular coagulation (DIC) according to four DIC guidelines. J Intensive Care. 2014;2(1):15. doi: 10.1186/2052-0492-2-15.

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Copyright (c) 2016 Somonova O.V., Elizarova A.L., Matveeva I.I.

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