Risk factors for intractable pleural effusion after liver resection.
BACKGROUND
Although intractable pleural effusion is a well-known complication after liver resection, risk factors for this condition have not been established.


METHODS
Records of 254 patients who underwent liver resection for hepatocellular carcinoma between January 1994 and December 2002 were reviewed. Postoperative pleural effusion that required thoracentesis or continuous drainage with or without pleurodesis was defined as intractable. Variables evaluated as risk factors included demographic factors, presence of cirrhosis, routine preoperative laboratory data, serum concentration of type IV collagen 7S domain (7S collagen), Child-Pugh class, preoperative interventions, including transcatheter arterial embolization (TAE), operative procedure, intraoperative blood loss, histology of noncancerous hepatic parenchyma, and major postoperative complications.


RESULTS
Postoperative intractable pleural effusion developed in 15 (5.9%) patients. Serum concentration of 7S collagen, preoperative transcatheter arterial embolization (TAE), and liver resection that included segments 7 and/or 8 were independent risk factors on multivariate analysis. In patients with high concentration of 7S collagen (> or = 8.0 ng/mL), the incidence of the complication was significantly lower in patients who had not undergone TAE than in those who had undergone TAE.


CONCLUSIONS
An increase in serum 7S collagen concentration (> or = 8.0 ng/mL) and preoperative TAE are independent and preoperative risk factors for the development of intractable pleural effusion after liver resection for HCC. Preoperative TAE should be avoided when possible in patients whose serum 7S collagen concentration is > or = 8.0 ng/mL.
Tanaka
Shogo
S
Second Department of Surgery, Osaka City University Medical School, Japan. m8827074@msic.med.osaka-cu.ac.jp
Kubo
Shoji
S
Tsukamoto
Tadashi
T
Hirohashi
Kazuhiro
K
Tanaka
Hiromu
H
Shuto
Taichi
T
Takemura
Shigekazu
S
Kinoshita
Hiroaki
H
D000368:Aged; D024141:Collagen Type IV / Q000097:blood; D004621:Embolization, Therapeutic; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010996:Pleural Effusion / Q000209:etiology*; D012307:Risk Factors
D024141:Collagen Type IV