title: Risk factors of postoperative ascites on hepatic resection for hepatocellular carcinoma.
abstract: OBJECTIVE
  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 postoperative 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.
authors.affiliation: Department of Surgery, Inha University College of Medicine, Incheon, Korea.
authors.forename: Seong Woon
authors.initials: SW
authors.lastname: Choi
authors.affiliation: Department of Surgery, Inha University College of Medicine, Incheon, Korea.
authors.forename: Woo Young
authors.initials: WY
authors.lastname: Shin
authors.affiliation: Department of Surgery, Inha University College of Medicine, Incheon, Korea.
authors.forename: Keon Young
authors.initials: KY
authors.lastname: Lee
authors.affiliation: Department of Surgery, Inha University College of Medicine, Incheon, Korea.
authors.forename: Seung Ik
authors.initials: SI
authors.lastname: Ahn
keywords: Ascites; Hepatectomy; Hepatocellular carcinoma