Prediction of intraoperative bleeding and blood transfusion in patients with recurrent retroperitoneal liposarcoma: a retrospective study

BACKGROUND: Surgery is the main treatment for recurrent retroperitoneal liposarcoma (RPLS). The aim of the present study was to explore the factors associated with blood loss during surgery for recurrent RPLS. METHODS: This retrospective study included patients with first recurrence of RPLS who were treated at our hospital between January 2015 and December 2019. Factors associated with intraoperative blood loss were identified by univariate and multivariate logistic regression analyses. Receiver-operating characteristic (ROC) curve analyses were conducted to evaluate whether tumor size and number of tumor-containing abdominal/pelvic zones were predictive of the need for blood transfusion. RESULTS: The study included 67 cases. The number of zones containing tumors was 1 in 4 cases (6%), 2 in 36 cases (53.7%), 3 in 14 cases (20.9%), and 4 in 13 cases (19.4%). Tumor size was associated with blood loss >500 mL [odds ratio (OR): 1.153, 95% confidence interval (CI): 1.051–1.266, P=0.003]. The number of tumor-containing zones was associated with blood loss >1,000 mL (OR: 3.161, 95% CI: 1.248–8.003, P=0.015) and >1,500 mL (OR: 2.674, 95% CI: 1.061–6.739, P=0.037). Multiple tumors were associated with blood loss >2,000 mL (OR: 3.161, 95% CI: 1.092–13.133, P=0.036) and >2,500 mL (OR: 2.674, 95% CI: 1.243–16.299, P=0.022). Tumor dedifferentiation was associated with blood loss >1,000 mL (OR: 4.802, 95% CI: 1.287–17.916, P=0.019) and >1,500 mL (OR: 9.249, 95% CI: 1.927–44.39, P=0.005). ROC curve analysis showed that tumor size >15.25 cm [area under the ROC curve (AUC): 0.772, P<0.001] and the number of tumor-containing zones >2.5 (AUC: 0.670; P=0.023) were predictive of the need for blood transfusion. CONCLUSIONS: The main finding of the present study was that a larger tumor size, a larger number of tumor-containing zones, multiple tumors, and dedifferentiation were independently associated with a larger volume of intraoperative blood loss in patients with recurrent RPLS. The tumor size >15.25 cm and the tumor area >2.5 areas predicted the need for blood transfusion. Formulating the intraoperative blood transfusion plan for recurrent RPLS, it is necessary to pay attention to two spatial factors, tumor size and affected area, rather than one of them.