Predicting pleural effusion and ascites following extended hepatectomy in the non-cirrhotic liver

Abstract

Background: There are cases in which intractable pleural effusion and/or ascites appear even in the non-cirrhotic liver following extended liver resection, making postoperative management difficult. In this study we investigated the risk factors for pleural effusion and ascites following extended hepatectomy.

Methods: Subjects were 50 patients between 1996 and 2003 who had hepatic metastasis of colorectal cancer, and who underwent extended liver resection of hemihepatectomy or greater at a time separate from the surgery for their colorectal cancer. The 50 patients were classified according to the presence or absence of pleural effusion and/or ascites, and compared for preoperative ICGR15, pre- and postoperative total serum protein and albumin levels, operating time, amount of blood loss, resected liver weight g/bodyweight kg (Hx ratio), intraoperative fluid replacement volume, period of surgery, operative procedure, use of serum and plasma derivatives, and use of catecholamines.

Results: In a univariate analysis of pleural effusion and ascites, the Hx ratio, period of surgery, operative procedure, use of fresh frozen plasma and use of albumin preparations were significant factors, but in a multivariate analysis only the Hx ratio was a significant independent factor. Among patients with an Hx ratio of 8 or above, many had postoperative pleural effusion and ascites.

Conclusions: The Hx ratio is a simple method for the evaluation of postoperative remnant liver function and is extremely useful as a predictive factor for pleural effusion and ascites following extended hepatectomy in the non-cirrhotic liver.