Mental adjustment at different phases in breast cancer trajectory: re-examination of factor structure of the Mini-MAC and its correlation with distress.

OBJECTIVE: The aim of this study is twofold. First, it aims to determine the factor structure of the Mini-Mental Adjustment to Cancer (Mini-MAC) Scale by using confirmatory factor analysis (CFA) to compare the three-factor, four-factor, and five-factor structures among 340 Taiwanese breast cancer patients. Second, it aims to test the difference in the correlations of coping strategies and the outcome measures between two populations: one-month newly diagnosed and five-year long-term survival patients. METHODS: Two samples, composed of 142 newly diagnosed and 198 long-term survival breast cancer patients, were recruited. Cancer-specific coping and distress were assessed via the Mini-MAC Scale and the Hospital Anxiety and Depression Scale (HADS), respectively. RESULTS: The CFA confirmed Watson's original five-factor structure fit the data best. The correlation difference between the two samples lies in the fighting spirit (FS), which correlated negatively with distress among the newly diagnosed sample but had no correlation among the long-term survivors. Moreover, fatalism (FA) was found to correlate positively with distress. CONCLUSIONS: The five-factor structure represents a more psychometrically sound measure of psychological adjustment in the current data set. The findings also support the argument that the relationships between coping and distress vary, to some degree, at different phases in the cancer trajectory. FS is only a positive predictor of psychological adjustment among newly diagnosed patients. Because of the exclusion of two items, FA showed a positive correlation with distress, a result that contradicts previous findings. Further theoretical and practical implications for FS and FA are discussed.

Rapid staining and immediate interpretation of fine-needle aspiration cytology for palpable breast lesions: diagnostic accuracy, mammographic, ultrasonographic and histopathologic correlations.

OBJECTIVE: We investigated the role and turn around time of rapid staining and immediate interpretation of fine-needle aspiration cytology (FNAC) for women with palpable breast lesions. STUDY DESIGN: A total of 408 FNAC specimens from 400 patients with palpable breast lesions was analyzed for immediate interpretation and preliminary cytologic diagnosis. All cytological diagnoses were correlated with subsequent alcohol-fixed Papanicolaou-stained slides, mammographic, ultrasonographic and histopathological findings. RESULTS: Of the 408 specimens, 243 (59.6%) were interpreted as benign, 37 (9.0%) atypical, 22 (5.4%) suspicious, 68 (16.7%) malignant, and 38 (9.3%) unsatisfactory. 132 of 408 (32.4%) had subsequent surgical procedures; the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 88.5, 100, 100, 81.9 and 92.4%, respectively. The average turn around time was 8.6 min. Mammographic results were available in 242 (59.3%) cases, with 112 (46.3%) undergoing surgical excision. In correlation with mammography and surgical pathology, the false-positive rate, false-negative rate, sensitivity, specificity and accuracy were 1.9, 10.5, 98.1, 89.5 and 95.8%, respectively. CONCLUSIONS: Rapid FNAC interpretation is a useful, effective diagnostic method for palpable breast lesions in our healthcare environment.

Is breast cancer the same disease in Asian and Western countries?

UNLABELLED: A mini-symposium was held in Montreal, Canada, at the International Surgical Week for the Breast Surgical International in 2007 addressing the question whether breast cancer is the same disease in Asian and Western countries. Numerous investigators from Asian and Western countries presented the epidemiologic and clinical outcome data of women with breast cancer. Although there are significant similarities, the striking difference is that the peak age for breast cancer is between 40 and 50 years in the Asian countries, whereas the peak age in the Western countries is between 60 and 70 years. Also, the incidence of breast cancer in Asia is rising and is associated with increased mortality. In the West, although the incidence is increasing, the mortality rate is definitely decreasing. Future prospective data collection from Asian and Western countries may provide further interesting epidemiologic and outcome data regarding the outcome of women with breast cancer from Asian and Western countries. BACKGROUND: Whether breast cancer is the same disease in Asian and Western countries was the topic of a 2007 Breast Surgery International symposium at International Surgical Week. METHODS: Participating investigators from China, Taiwan, India, Japan, South Korea, Sweden, Canada, and the United States were asked beforehand to provide data on the epidemiology and treatment outcome of women in their countries. RESULTS: Comparisons of the epidemiologic and clinical outcome data of women with breast cancer showed significant similarities, but the striking difference is that the peak age is between 40 and 50 years in Asian countries, but is between 60 and 70 years in Western countries. The incidence of breast cancer in Asia is rising and is associated with increased mortality. In the West, although the incidence is also increasing, the mortality rate is definitely decreasing. DISCUSSION: Future prospective data collection from Asian and Western countries may provide further interesting epidemiologic and outcome data regarding the outcome of women with breast cancer from Asian and Western countries.

Successful management of latrogenic aortoduodenal fistula by intraaortic endovascular stent-graft and duodenal diversion.

Aortoduodenal fistula is usually fatal if not treated promptly. Long-term results are also not always satisfactory. A 53-year-old female patient suffered from massive hematemesis and shock due to an iatrogenic aortoduodenal fistula which was made during a laparoscopic total colectomy. Immediate closure of fistula with duodenal diversion by occlusion of duodenal lumen proximal to the fistula, bilateral truncal vagotomy and pyloroduodenojejunostomy were performed. Endoluminal aortic stent graft was inserted 3 days later. The patient remained disease-free 3 years after operation. With a prompt diagnosis, duodenal diversion with endoluminal aortic stent may be a better option for iatrogenic aortoduodenal fistula.

Validity of sentinel lymph node biopsy in Taiwanese breast cancer patients.

BACKGROUND/PURPOSE: The clinical validity of sentinel lymph node (SLN) biopsy in Taiwanese breast cancer patients from 16 institutes in two consecutive periods was analyzed. METHODS: Data from the initial period between January 3, 1999 and July 2004 and data from the later period after August 2004 to February 2005 were compared. Data on the use of a tracer, SLN identification, harvest and examination, false negative rate (FNR) and the number of patients spared axillary lymph node dissection (ALND) were analyzed. RESULTS: A total of 3308 patients with clinical axilla negative breast cancer underwent SLN biopsies in 16 hospitals (11 in both periods and 5 in the period before August 2004). Comparison of data from the two periods revealed that in the later period, use of combined blue dye and isotope tracer increased from 40% to 80%, the 95% SLN biopsy success rate increased from 50% to 80%, hospitals conducting intraoperative SLN examination increased from 80% to 93%, and the 95% match to permanent section rate increased from 30% to 80%. In the initial period, eight hospitals had less than 7% FNR, while in the later period this had decreased to 4.1% in these hospitals. Another three hospitals had FNR greater than 7% in the initial period, which had decreased to 0% in the later period. Hospitals with more than 100 cases of SLN biopsy had an average 3.8% FNR, whereas hospitals with less than 100 cases of SLN biopsy experience had an 8.2% FNR (p < 0.01). CONCLUSION: This study found that the SLN biopsy success rate increased after the use of combined tracers and with experience. FNR was controlled to within 5% among breast surgeons with accumulated experience exceeding 100 cases. It is recommended that ALND-sparing surgery be suspended temporarily in hospitals with FNR greater than 5%.

Experiences with cytoreduction surgery plus hyperthermic intraperitoneal chemotherapy in Taiwan.

Our hospital was the first institution to offer cytoreduction surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC) in Taiwan. Therefore, we report our experience and outcomes among patients who underwent HIPEC.Since 2002, 164 eligible patients underwent HIPEC, and we excluded cases of laparoscopic or prophylactic HIPEC. The cases were categorized according to whether they were treated before 2012 (Period 1: 80 cases) or after 2012 (Period 2: 84 cases).The rates of surgical morbidity were 46.3% during Period 1 and 20.2% during Period 2 (P < .01), and the rates of severe complications were 25% during Period 1 and 9.5% during Period 2 (P < .01). The 5-year overall survival rate was 35.8%, with rates of 13.4% for gastric cancer, 27.3% for colon cancer, 70.0% for appendiceal cancer, and 52.4% for ovarian cancer (median follow-up: 34 months). The survival rate was 42.1% when we achieved a cytoreduction score of 0/1, compared with 21.1% in the group with a cytoreduction score of 2/3 (P < .01). Severe complications were associated with a 5-year survival rate of 23.4%, compared with 37.9% among cases without severe complications (P = .01). Complete cytoreduction was achieved in 78.6% of the patients if they underwent their first surgery at our hospital.We have become an experienced hospital for CRS plus HIPEC. Although our complication rate for CRS plus HIPEC was high, it was within the acceptable range. Long-term survival was achieved in a few cases.

Role of glucocorticoid receptor in serosa-involved gastric carcinoma after gastrectomy.

Glucocorticoid receptor (GR) was first found in the cytosol of gastric cancer tissue more than 15 years ago. At present, most gastric cancers are diagnosed at the advanced stage. To elucidate the role of GR in gastric cancer, the GR levels of the cancer tissue of 75 consecutive patients with grossly serosa-involved gastric carcinoma were determined by the dextran-coated charcoal method. The clinicopathologic characteristics and long-term survival duration were compared in patients with GR-positive and GR-negative cancer cells. We found that GR could be detected in the cytosol of cancer cells in 31 (41.3%) of the gastric cancer patients with a median concentration of 18.5 (range, 1.03-73.9) fmol/mg protein. No significant differences could be found in any clinicopathologic characteristic between the patients with GR-positive and GR-negative cancers. After multivariate analysis, gross Borrmann's type, metastatic lymph node number, and GR positivity were the independent prognostic factors after gastrectomy for serosa-involved gastric carcinoma. GR-positive gastric cancer had a worse survival rate than GR-negative gastric cancer. Multimodality adjuvant therapies should be considered in patients with GR-positive serosa-involved gastric carcinoma.

Evolution of breast cancer screening in countries with intermediate and increasing incidence of breast cancer.

BACKGROUND: Few studies have been published regarding the practice of breast cancer screening in Asian countries. AIMS: The present study illustrates how the health policy for breast cancer screening has evolved in Taiwan from selective mammographic screening within a high-risk group, firstly to a programme of physical examination by public health nurses, and finally to a two-stage breast cancer screening programme, with a risk assessment followed by mammography for those at moderate to high risk. DATA SOURCES: Breast cancer screening has evolved from 1995 to 2004 in Taiwan in three stages: (1) selective screening for breast cancer with mammography, ultrasound and physical examination only in first-degree relatives of breast cancer cases (1995-1998); (2) a programme of mass screening (1999-2001) with physical examination by public health nurses; and (3) two-stage breast cancer screening with a risk factor questionnaire and mammography for those deemed at moderate-to-high risk (2002-2004). The questionnaire was based on significant risk factors in a previous epidemiological study, in conjunction with the physical examination programme, a risk score was constructed from the logistic regression coefficients from the previous study, and women with a score above the median in the previous epidemiological study were assigned to mammography. RESULTS: Two-stage mammography screening had the most favourable results compared with the two previous screening regimes. It had a positive predictive value of recall after mammography of 14%, compared with 8% for selective screening and 2% for physical examination. Of screen-detected cancers in the two-stage programme, 71% were either ductal carcinoma in situ or stage T1, compared with 61% for selective screening and 60% for physical examination. The area under the receiver operating characteristic curve was 71% for the two-stage programme. CONCLUSIONS: For a low- to medium-risk country such as Taiwan, two-stage screening has acceptable parameters of recall and cancer detection, and compares well with other screening strategies.

Surgical results of hepatic resection for hepatocellular carcinoma with gross diaphragmatic invasion.

BACKGROUND/AIMS: Gross diaphragmatic invasion is not uncommon in patients undergoing hepatectomy for hepatocellular carcinoma. The aim of the study is to evaluate retrospectively the surgical results of hepatocellular carcinoma with gross diaphragmatic invasion undergoing en-bloc resection of diaphragm. METHODOLOGY: Between January 1989 and December 2002, 640 patients underwent curative resections for hepatocellular carcinoma in our hospital. Fifty-three patients (8.3%) who had hepatocellular carcinoma with gross diaphragmatic invasion found during operation undergoing en-bloc resection of diaphragm were assigned to group A. The other 587 patients who had hepatocellular carcinoma without gross diaphragmatic invasion were assigned to group B. The clinicopathological features, operative mortality and morbidity and long-term result of the patients between group A and B were compared. RESULTS: Of the 53 patients in group A with gross diaphragmatic invasion of hepatocellular carcinoma undergoing en-bloc resection of diaphragm, seven (13.2%) were pathologically proved to have muscular invasion of diaphragm and the other 46 (86.8%) were fibrous adhesion only or free of tumor. Primary repair of diaphragm was adequate in 52 patients (98.1%) and one required a mesh repair, Thirteen patients (24.5%) developed postoperative complication but no operative mortality occurred. There was no significant difference in operative mortality and postoperative complication rate between the two groups of patients with (group A) and without (group B) gross diaphragmatic invasion. If compared by each TNM staging (stage I, II and III) there was no significant difference between the patients of group A and B in five-year cumulative and disease-free survival. Among the 53 patients in group A, the long-term prognosis was also not significantly different between the patients with (group A1) and without (group A2) histological muscular invasion. CONCLUSIONS: En-bloc resection of diaphragm in patients with gross diaphragmatic invasion of hepatocellular carcinoma is justified since it does not significantly increase the operative mortality or postoperative complication rate and the long-term prognosis at each TNM staging is comparable to that of patients without gross diaphragmatic invasion.

Appraisal of concomitant splenectomy in liver resection for hepatocellular carcinoma in cirrhotic patients with hypersplenic thrombocytopenia.

BACKGROUND: Liver resection usually is not recommended for hepatocellular carcinoma (HCC) in cirrhotic patients with portal hypertension. The role of concomitant splenectomy in liver resection for HCC in cirrhotic patients with hypersplenic thrombocytopenia (HT) resulting from portal hypertension remains undefined. METHODS: Among 526 cirrhotic patients who underwent liver resection for HCC, 41 underwent a concomitant splenectomy (Sp group) because of HT (platelet count

Roles of the glucocorticoid receptor in resectable hepatocellular carcinoma.

BACKGROUND: The glucocorticoid receptor (GR) was discovered in the cytosol of hepatocellular carcinoma (HCC) cells more than 10 years ago. However, the influence of the GR on the prognosis of HCC after liver resection remains unclear. METHODS: Ninety-two consecutive patients with HCC who survived liver resection and who did not receive any preoperative neoadjuvant therapy were enrolled in this study. The GR level in cytosol of cancerous tissue was determined by the dextran-coated charcoal method. The clinicopathologic characteristics and long-term prognosis of patients with GR-positive tumors (GR-positive group) were compared with those of patients with GR-negative tumors (GR-negative group). RESULTS: GR was found in 63 patients (68.5%) with a mean +/- SEM concentration of 26.97 +/- 4.05 fmol/g protein. There were no significant differences in patient clinicopathologic characteristics between GR-positive and GR-negative groups. The 5-year disease-free and actuarial survival rates for GR-positive and GR-negative groups were 21.6% and 44.4% (P =.002) and 57.2% and 83.3% (P =.0003), respectively. After multivariate analysis was performed, GR positivity was found to be an independent prognostic factor of disease-free and actuarial survival after liver resection for HCC. CONCLUSIONS: The GR can be found in the cytosol of most HCCs and is an independent prognostic factor of HCC after liver resection. Patients with GR-positive HCC have lower survival rates than those with GR-negative HCC.

Occlusion of hepatic blood inflow for complex central liver resections in cirrhotic patients: a randomized comparison of hemihepatic and total hepatic occlusion techniques.

BACKGROUND: Intermittent occlusion of hepatic blood inflow by means of a hemihepatic or total hepatic occlusion technique is essential for reducing operative blood loss. Central liver resection to preserve more functioning liver parenchyma is mandatory for centrally located liver tumors in patients with cirrhosis, but it requires a longer overall hepatic ischemic time because of a wide transection plane. No controlled comparison has been performed for the 2 techniques in these operations. HYPOTHESIS: Hemihepatic inflow occlusion may be beneficial in cirrhotic patients who undergo complex central hepatectomy with a wide liver transection plane. DESIGN: A prospective, randomized study. SETTING: University hospital and tertiary referral center. PATIENTS: During liver parenchymal transection, 58 cirrhotic patients who underwent complex central liver resections with a wide transection plane were prospectively randomized into 2 groups. In the group undergoing total hepatic inflow clamping (group T; n = 28), occlusion of hepatic blood inflow was performed for 15 minutes with declamping for 5 minutes. In the group undergoing selective clamping of ipsilateral blood inflow (group H; n = 30), clamping was performed for 30 minutes with declamping for 5 minutes. INTERVENTION: Comparison of patient backgrounds, operative procedures, and early postoperative results. MAIN OUTCOME MEASURES: Operative blood loss, need for blood transfusion, and postoperative morbidity. RESULTS: The patients' backgrounds, operative procedures, and area of liver transection plane were not significantly different between the 2 groups. In all patients, the liver transection areas were greater than 60 cm(2) and overall liver ischemic times were greater than 60 minutes. The amount of operative blood loss and incidence of blood transfusion were significantly greater in group T because of greater blood loss during declamping. Overall liver ischemic and total operative times, postoperative morbidity, and postoperative changes in liver enzyme levels were not significantly different between groups. No in-hospital deaths occurred in either group. CONCLUSIONS: Intermittent hemihepatic and total occlusion of hepatic blood inflow are safe in cirrhotic patients with an overall ischemic time of greater than 60 minutes. However, for complex liver resections with an estimated liver transection plane of greater than 60 cm(2), hemihepatic occlusion of blood inflow, if feasible, may be recommended in cirrhotic patients to reduce operative blood loss and the incidence of blood transfusion under our defined occlusion time.

Predicting multidrug resistance-related protein and P-glycoprotein expression with technetium-99m tetrofosmin mammoscintigraphy.

The purpose of this study was a retrospective survey of 40 patients with infiltrating ductal breast carcinoma to evaluate the relationships between the degree of accumulation of technetium-99m tetrofosmin (Tc-TF), multidrug resistance-related protein (MRP) expression and P-glycoprotein (Pgp) expression in breast cancer tissue. Immunohistochemical analysis (IHA) was performed on pathological specimens of the 40 breast cancers to determine Pgp and MRP expression. The results of IHA, were used as the basis for dividing the 40 breast cancers into four groups: A, 10 tumors with positive MRP and Pgp expressions; B, 10 tumors with positive MRP but negative Pgp expression; C, 10 tumors with negative MRP but positive Pgp expression; and D, 10 tumors with negative MRP and Pgp expression. All 40 patients had undergone Tc-TF mammoscintigraphy to calculate breast cancer uptake of Tc-TF to background uptake (T/B) ratios before IHA and surgery/biopsy. Of the four groups, group A had the lowest T/B ratios (1.15+/-0.10) and group D, the highest (2.19+/-0.15) (P<0.05). The T/B ratios in groups B (1.36+/-0.27) and C (1.37+/-0.26) were intermediate between those of groups A and D. In addition, the T/B ratios were statistically significantly lower in group A than in group B or C, and statistically significantly higher in groups D than in groups B or C (P<0.05). However, no significant difference in T/B ratio was found between groups B and C (P>0.05). Our results indicate that Tc-TF mammoscintigraphy is helpful for in vivo determination of Pgp and MRP expression in breast cancers.

Radiation inactivation analysis of progesterone receptor in human uterine cytosol.

It is believed that human progesterone receptor (PR) contains a ligand binding subunit A (83 kDa) or subunit B (120 kDa) and 2 copies of heat shock proteins (hsp90) of molecular weight 90 kDa. To elucidate the mechanism of hormone binding, we employed radiation inactivation to determine its functional size. The functional masses determined in the presence of glycerol, molybdate and potassium chloride were 120+/-14, 124+/-13 and 130+/-20 kDa, respectively. From scatchard plot analysis, the radiation decreased the binding sites and increased the binding affinity of PR with ligand. The functional masses of PR dissolved in the three variant buffers were similar to the molecular weight of PR subunit B. The results implied that PR subunit B could bind with ligand despite hsp90 and hsp90 was not involved in the PR binding to progesterone.

The necessity of hepatic vein reconstruction after resection of cranial part of the liver and major hepatic veins in cirrhotic patients.

BACKGROUND: The necessity of hepatic vein reconstruction (HVR) after resection of cranial part of the liver and major hepatic vein(s) in cirrhotic patients when residual liver is insufficient for a major hepatectomy remains unclear. METHODS: Fifty-two cirrhotic patients who underwent resection of cranial part of the liver and hepatic vein(s) for liver neoplasms were divided retrospectively into 3 groups based on the volume of the congestive area of the remnant liver after hepatectomy: group A, 28 patients, the volume of the congestive area was ≤20% of the residual liver volume and underwent no HVR; group B, 7 patients, the volume of the congestive area was >20% of residual liver volume and underwent no HVR; and group C, 17 patients, in whom HVR was performed (the volume of the congestive area was >20% of residual liver volume in 16 and <20% in 1). Background characteristics and postoperative results were compared between the groups. RESULTS: Although group C patients had a significantly longer operative time, their postoperative courses were similar to group A patients. Group B patients had a significantly longer postoperative hospital stay and a greater postoperative morbidity and 90-day mortality. No 90-day mortality ensued in the group A and C patients. CONCLUSION: In selected cirrhotic patients whose remnant liver is insufficient for major hepatectomy, HVR appears to be safe and desirable after resection of the cranial part of liver and hepatic vein when the volume of congestive area of liver remnant exceeds 20% of future residual liver volume.

WITHDRAWN: Predicting multidrug resistance-related protein and P-glycoprotein expression with technetium-99m tetrofosmin mammoscintigraphy.

The publisher regrets that this is an accidental duplication of an article that has already been published in The Breast, 12 (2003) 58-62, doi:10.1016/S0960-9776(02)00136-4. The duplicate article has therefore been withdrawn.

The influence of high serum testosterone levels on the long-term prognosis in male patients undergoing hepatectomy for early stage hepatocellular carcinoma without vascular invasion.

BACKGROUND: The influence of high serum testosterone levels on the long-term prognosis in male patients undergoing hepatectomy for hepatocellular carcinoma (HCC) remains to be fully elucidated. The aim of the present study was to conduct a retrospective investigation of the impact of high serum testosterone levels on the risk of tumor recurrence and long-term prognosis in male patients undergoing hepatectomy for early stage HCC without vascular invasion. METHODS: Between August 1995 and March 1999, 42 male patients undergoing curative hepatectomy for HCC of tumor-node-metastasis (TNM) stages I and II without vascular invasion were enrolled in the study. Preoperative serum testosterone concentration was measured. The clinicopathological features, tumor recurrence rates, and 5-year disease-free and actuarial survival after hepatectomy were compared between the patients with serum testosterone levels in the upper half (group I, n = 21) and the patients in the lower half (group II, n = 21). RESULTS: The background and clinicopathological features did not differ significantly between groups I and group II. All survivors were followed up for more than 5 years. Until March 2005, patients in group I, with serum testosterone levels in the upper half, had a significantly higher percentage of 5-year tumor recurrence than group II, with lower testosterone levels (76.2% versus 28.6%; p < 0.005). The patients in group I also had a significantly inferior 5-year disease-free (p < 0.01) and actuarial (p < 0.05) survival rates than patients in group II. CONCLUSIONS: Male patients with high serum testosterone levels undergoing hepatectomy for early stage HCC without vascular invasion have significantly higher 5-year tumor recurrence rates and an inferior long-term prognosis than patients with low testosterone levels. These findings signal a strategy of adjuvant anti-androgen treatment selectively targeted for the male patients with high serum testosterone levels after hepatectomy for early stage HCC without vascular invasion to achieve better long-term outcome.

Perioperative parenteral tranexamic acid in liver tumor resection: a prospective randomized trial toward a "blood transfusion"-free hepatectomy.

OBJECTIVE: To examine the feasibility of a real "blood transfusion"-free hepatectomy in a large group of patients with liver tumors. SUMMARY BACKGROUND DATA: Bleeding control and blood transfusion remains problematic in liver resection. A real "blood transfusion"-free hepatectomy in a large group of patients has rarely been reported. The impact of tranexamic acid (TA), an antifibrinolytic agent, on blood transfusion in liver resection is unknown. METHODS: A prospective double-blind randomized trial was performed on elective liver tumor resections. In group A, TA 500 mg was intravenously administered just before operation followed by 250 mg, every 6 hours, for 3 days. In group B, only placebo was given. The patients' background, blood transfusion rates, and early postoperative results in the 2 groups were compared. Factors that influenced blood requirement were analyzed. RESULTS: There were 108 hepatectomies in group A and 106 hepatectomies in group B. The patients' backgrounds, operative procedures, and hepatectomy extent did not significantly differ between the 2 groups. Although the differences of the operative morbidity and postoperative stay were not significant, a significantly lower amount of operative blood loss, lower blood transfusion rate, shorter operative time, and lower hospital costs were found in group A patients. No patient in group A received blood transfusion. No hospital mortality occurred in either group. Tumor size and use of TA were independent factors that influenced blood transfusion. CONCLUSIONS: Perioperative parenteral use of TA reduced the amount of operative blood loss and the need for blood transfusion in elective liver tumor resection. A real "blood transfusion"-free hepatectomy may be feasible with the assistance of parenteral TA.