title: Risk factors for intractable pleural effusion after liver resection.
abstract: 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.
authors.affiliation: Second Department of Surgery, Osaka City University Medical School, Japan. m8827074@msic.med.osaka-cu.ac.jp
authors.forename: Shogo
authors.initials: S
authors.lastname: Tanaka
authors.forename: Shoji
authors.initials: S
authors.lastname: Kubo
authors.forename: Tadashi
authors.initials: T
authors.lastname: Tsukamoto
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Hirohashi
authors.forename: Hiromu
authors.initials: H
authors.lastname: Tanaka
authors.forename: Taichi
authors.initials: T
authors.lastname: Shuto
authors.forename: Shigekazu
authors.initials: S
authors.lastname: Takemura
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Kinoshita
mesh_terms: 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
chemical_list: D024141:Collagen Type IV