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KMID : 0870420160200040153
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Korean Journal of Hepato-Biliary-Pancreatic Surgery
2016 Volume.20 No. 4 p.153 ~ p.158
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Risk factors of postoperative ascites on hepatic resection for hepatocellular carcinoma
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Choi Seong-Woon
Shin Woo-Young
Lee Keon-Young
Ahn Seung-Ik
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Abstract
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Backgrounds/Aims: The aim of this study was to identify the risk factors of the development of large amounts of ascites (LA) after hepatic resection for hepatocellular carcinoma (HCC).
Methods: The medical records of 137 consecutive patients who underwent hepatic resection for HCC from January 2010 to December 2014 were retrospectively reviewed. Patients were divided into two groups: LA group, with ascites drainage ＞500 cc per day over 3 days (n=37) and control group (n=100). Preoperative and intraoperative clinical variables were compared between the two groups.
Results: Thirty-seven (27.0%) patients developed LA. Platelet counts of ＜100,000/mm3, ICG-R15 ＞10%, CTP scores of 6 or 7 points, major resection, the presence of cirrhosis, preoperative ascites, and portal hypertension were significantly more frequent in LA group. Multivariate analysis revealed that a higher CTP score (HR=4.1), the presence of portal hypertension (HR=26.7), and major resection (HR=18.5) were independent and significant risk factors of post-operative ascites development. Persistent refractory ascites developed in 6 (16.2%) patients who succumbed to hepatic failure during follow-up.
Conclusions: Patients with a 6 or 7 point CTP score, major hepatic resection and/or portal hypertension were more likely to develop LA and experience deterioration of liver function after surgery. The selection of patients for hepatic resection should be based on a balanced assessment of the benefits of HCC treatment and risk of postoperative liver failure.
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KEYWORD
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Hepatocellular carcinoma, Ascites, Hepatectomy
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