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 Россия

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 Россия

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 Россия

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

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