To investigate the effect of laparoscopic liver resection(LLR) on intraoperative bleeding in hepatocellular carcinoma (HCC) patients with thrombocytopenia.

The clinical data of 141 patients who underwent LLR for HCC in Department of General Surgery Center, Capital Medical University Affiliated Youan Hospital from Apr.2020 to Nov. 2022 were analyzed retrospectively. According to the level of PLT, they were divided into PLT reduced group and PLT normal group. The blood loss during operation, the proportion of hepatic portal occlusion, the time of hepatic portal occlusion, the time of operation, the amount of blood transfusion during operation, whether drainage tubes were placed during operation, the complications after operation, and the length of hospital stay were compared between the two groups, To investigate the effect of PLT level on the amount of bleeding and the safety of LLR.

141 patients completed LLR without intraoperative infusion of red blood cells. The median bleeding volume of PLT reduced group and PLT normal group was 100 mL and 50 mL respectively. There was no statistical difference between the two groups (P=0.111). There was no statistical difference between the two groups in the time of hepatic portal occlusion, the operation time, the proportion of hepatic portal occlusion, and the amount of intraoperative plasma transfusion. The proportion of drainage tubes of PLT reduced group was significantly higher than that of PLT normal group (94.29% vs 78.50%, P=0.040) There was no statistical difference in the incidence of postoperative complications between the PLT reduced group and the PLT normal group (20.00% vs 10.28%, P=0.149). The hospital stay after surgery was 7 days and 6 days respectively and there was no difference between the two groups (P=0.062).

LLR is safe and feasible for HCC patients with thrombocytopenia through careful anatomy, appropriate hepatic portal occlusion and low central venous pressure technology, and LLR without blood transfusion can also be performed by experienced hepatobiliary surgeon.