Ueno2

Clinical bottom line:

1. HBOT was associated with lower serum lactate and bilirubin levels, and higher hepatic venous oxygen saturation at one day postoperatively. 2. There were no clear differences between groups in the chance of complications or survival.

• • Citation/s:

1. Ueno S, Sakoda M, Kurahara H, Iino S, Minami K, Ando K, Mataki Y, Maemura K, Ishigami S, Shinchi H, Natsugoe S. Safety and efficacy of early postoperative hyperbaric oxygen therapy with restriction of transfusions in patients with HCC who have undergone partial hepatectomy. Langenbeck's archives of surgery. 2011 Jan 1;396(1):99-106. Lead author's name and fax: ueno1@m.kufin.kagoshima-u.ac.jp Three-part Clinical Question: For patients undergoing liver resection for hepatocellular carcinoma, does the addition of hyperbaric oxygen therapy postoperatively result in any reduction in postoperative complications?

Search Terms: Hepatocellular carcinoma, blood transfusion, hepatectomy

• • The Study: Non-blinded concealed randomised controlled trial with intention-to-treat.

The Study Patients: Consecutive patients with HCC and scheduled for elective hepatectomy and where the postoperative haemoglobin was <9 g/dl. Patients excluded if prolonged bleeding or adjuvant post-operative chemotherapy indicated.. Control group (N = 21; 21 analysed): Standard postoperative care. Blood transfused if Hb <7.0 g/dl>< 7g/dl. Experimental group (N = 20; 20 analysed): As above plus early HBOT at 2ATA breathing 100% oxygen for 60 minutes at 3 hours postoperatively, 24 hours postoperatively and 48 hours if patients were still hypoxic or had high blood bilirubin level.

• • The Evidence:

Outcome	Time to Outcome	Control group	HBO group	Relative risk reduction	Absolute risk reduction	NNT
Transfusion required	48 hours	0.62	0.65	5%	0.03	32
^			95% CI:	-43% to 53%	-0.26 to 0.33	NNT 3 to INF; NNH 4 to INF
Complications		0.33	0.20	40%	0.13	8
^			95% CI:	-40% to 100%	-0.13 to 0.40	NNT 2 to INF; NNH 7 to INF

Measure		Control Group		HBO Group	Difference	95% CI
^	Mean	SD	Mean	SD	^	^
Hepatic vein oxygen saturation (ShvO2) at one day (%)	55	7.5	62.5	11.5	7.50	1.4 to 13.6
Serum lactate at one day (mmol/L)	3.4	1.3	2.6	1.1	0.80	0.04 to 1.56
Serum bilirubin (mg/dl)	2.95	0.7	2.1	0.9	0.85	0.34 to 1.36

• • Comments:

1. Survival analysis suggested no clear benefit in 60 month survival, although there was some indication of benefit (40% versus 26% survival at 60 months, P = 0.12). 2. The figures for mean and standard deviations above have been read from graphs rather than taken directly from the paper. 3. Small study lacking power to exclude clinically significant benefits.

Appraised by: Mike Bennett. POWH; Monday, 22 January 2018 Email: m.bennett@unsw.edu.au

Kill or Update By: January 2022

BACK