Post-hepatectomy Refractory Ascites in Cirrhotic Patients with Hepatocellular Carcinoma: Risk Factor Analysis to Overcome this Problematic Complication.
Refractory ascites is a serious post-hepatectomy complication in cirrhotic patients with hepatocellular carcinoma (HCC). In order to avoid this complication, surgeons should preserve as much liver parenchyma as possible in performing hepatectomy in such patients. However, we still occasionally encounter refractory ascites even after limited or small hepatectomy. The aim of this study was to identify risk factors for post-hepatectomy refractory ascites in cirrhotic patients, focusing on limited or small hepatectomy.



The data of 73 cirrhotic patients with HCC who underwent limited or small hepatectomy were analyzed. Limited or small hepatectomy was defined as hepatectomy equal to or of less than subsegmentectomy. We compared the clinicopathological factors between patients with and without postoperative refractory ascites.



Fourteen cirrhotic patients suffered postoperative refractory ascites. Total cholesterol, duration of operation, duration of Pringle maneuver, resection of segment VII, intraoperative blood loss, and intraoperative blood transfusion were found to be significant risk factors for postoperative refractory ascites in univariate analyses. Multivariate analysis revealed that resection of segment VII was an independent risk factor.



Resection of segment VII necessitates extensive dissection of the right triangular or coronary ligaments, which could explain that it was an independent risk factor for post-hepatectomy refractory ascites. Surgeons should avoid extensive dissection of these ligaments in order to avoid this detrimental complication.
Department of Surgery, Fukuoka City Hospital, Fukuoka, Japan itoshin@surg2.med.kyushu-u.ac.jp.|Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Shinji
S
Itoh
Department of Surgery, Fukuoka City Hospital, Fukuoka, Japan.
Hideaki
H
Uchiyama
Department of Surgery, Fukuoka City Hospital, Fukuoka, Japan.
Yasuharu
Y
Ikeda
Department of Surgery, Fukuoka City Hospital, Fukuoka, Japan.
Kazutoyo
K
Morita
Department of Surgery, Fukuoka City Hospital, Fukuoka, Japan.
Noboru
N
Harada
Department of Surgery, Fukuoka City Hospital, Fukuoka, Japan.
Keishi
K
Sugimachi
Department of Surgery, Fukuoka City Hospital, Fukuoka, Japan.
Hirofumi
H
Kawanaka
Department of Surgery, Fukuoka City Hospital, Fukuoka, Japan.
Daisuke
D
Korenaga
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Tomoharu
T
Yoshizumi
Department of Surgery, Fukuoka City Hospital, Fukuoka, Japan.
Kenji
K
Takenaka
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Yoshihiko
Y
Maehara
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001201:Ascites / Q000150:complications / Q000209:etiology*; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000473:pathology / Q000601:surgery*; D002784:Cholesterol / Q000378:metabolism; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000473:pathology / Q000601:surgery*; D008113:Liver Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications; D012044:Regression Analysis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors
D002784:Cholesterol
Refractory ascites; cirrhosis; hepatocellular carcinoma hepatectomy