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. 2021 Nov;25(11):2823-2834.
doi: 10.1007/s11605-021-04952-z. Epub 2021 Mar 9.

The Impact of Postoperative Ascites on Survival After Surgery for Hepatocellular Carcinoma: a National Study

Simone Famularo #  1   2 , Matteo Donadon #  3 , Federica Cipriani  4 , Francesco Ardito  5 , Maurizio Iaria  6 , Francesca Carissimi  7   8 , Pasquale Perri  9 , Tommaso Dominioni  10 , Matteo Zanello  11 , Simone Conci  12 , Sarah Molfino  13 , Fabrizio D'Acapito  14 , Paola Germani  15 , Cecilia Ferrari  16 , Stefan Patauner  17 , Enrico Pinotti  18 , Ivano Sciannamea  19 , Marco Garatti  20 , Enrico Lodo  21 , Albert Troci  22 , Antonella Delvecchio  23 , Antonio Floridi  24 , Davide Paolo Bernasconi  25 , Luca Fumagalli  26 , Marco Chiarelli  26 , Riccardo Memeo  23 , Michele Crespi  22 , Giacomo Zanus  21 , Giuseppe Zimmitti  20 , Adelmo Antonucci  19 , Mauro Zago  26 , Antonio Frena  17 , Guido Griseri  16 , Paola Tarchi  15 , Giorgio Ercolani  14 , Gian Luca Baiocchi  13 , Andrea Ruzzenente  12 , Elio Jovine  11 , Marcello Maestri  10 , GianLuca Grazi  9 , Raffaele Dalla Valle  6 , Felice Giuliante  5 , Luca Aldrighetti  4 , Fabrizio Romano  7   8 , Guido Torzilli  3 ; HE.RC.O.LE.S. Group
Collaborators, Affiliations

The Impact of Postoperative Ascites on Survival After Surgery for Hepatocellular Carcinoma: a National Study

Simone Famularo et al. J Gastrointest Surg. 2021 Nov.

Abstract

Background: Postoperative ascites (POA) is the most common complication after liver surgery for hepatocarcinoma (HCC), but its impact on survival is not reported. The aim of the study is to investigate its impact on overall survival (OS) and disease-free survival (DFS), and secondarily to identify the factors that may predict the occurrence.

Method: Data were collected from 23 centers participating in the Italian Surgical HCC Register (HE.RC.O.LE.S. Group) between 2008 and 2018. POA was defined as ≥500 ml of ascites in the drainage after surgery. Survival analysis was conducted by the Kaplan Meier method. Risk adjustment analysis was conducted by Cox regression to investigate the risk factors for mortality and recurrence.

Results: Among 2144 patients resected for HCC, 1871(88.5%) patients did not experience POA while 243(11.5%) had the complication. Median OS for NO-POA group was not reached, while it was 50 months (95%CI = 41-71) for those with POA (p < 0.001). POA independently increased the risk of mortality (HR = 1.696, 95%CI = 1.352-2.129, p < 0.001). Relapse risk after surgery was not predicted by the occurrence of POA. Presence of varices (OR = 2.562, 95%CI = 0.921-1.822, p < 0.001) and bilobar disease (OR = 1.940, 95%CI = 0.921-1.822, p: 0.004) were predictors of POA, while laparoscopic surgery was protective (OR = 0.445, 95%CI = 0.295-0.668, p < 0.001). Ninety-day mortality was higher in the POA group (9.1% vs 1.9% in NO-POA group, p < 0.001).

Conclusion: The occurrence of POA after surgery for HCC strongly increases the risk of long-term mortality and its occurrence is relatively frequent. More efforts in surgical planning should be made to limit its occurrence.

Keywords: Disease-free survival; Hepatocellular carcinoma; Liver surgery; Overall survival; Postoperative ascites; Postoperative complications.

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References

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