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

Authors :
Simone, Famularo
Matteo, Donadon
Federica, Cipriani
Francesco, Ardito
Maurizio, Iaria
Francesca, Carissimi
Pasquale, Perri
Tommaso, Dominioni
Matteo, Zanello
Simone, Conci
Sarah, Molfino
Fabrizio, D'Acapito
Paola, Germani
Cecilia, Ferrari
Stefan, Patauner
Enrico, Pinotti
Ivano, Sciannamea
Marco, Garatti
Enrico, Lodo
Albert, Troci
Antonella, Delvecchio
Antonio, Floridi
Davide Paolo, Bernasconi
Luca, Fumagalli
Marco, Chiarelli
Riccardo, Memeo
Michele, Crespi
Giacomo, Zanus
Giuseppe, Zimmitti
Adelmo, Antonucci
Mauro, Zago
Antonio, Frena
Guido, Griseri
Paola, Tarchi
Giorgio, Ercolani
Gian Luca, Baiocchi
Andrea, Ruzzenente
Elio, Jovine
Marcello, Maestri
GianLuca, Grazi
Raffaele Dalla, Valle
Felice, Giuliante
Luca, Aldrighetti
Fabrizio, Romano
Guido, Torzilli
Source :
Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract. 25(11)
Publication Year :
2020

Abstract

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.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.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 (p0.001). POA independently increased the risk of mortality (HR = 1.696, 95%CI = 1.352-2.129, p0.001). Relapse risk after surgery was not predicted by the occurrence of POA. Presence of varices (OR = 2.562, 95%CI = 0.921-1.822, p0.001) 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, p0.001). Ninety-day mortality was higher in the POA group (9.1% vs 1.9% in NO-POA group, p0.001).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.

Details

ISSN :
18734626
Volume :
25
Issue :
11
Database :
OpenAIRE
Journal :
Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract
Accession number :
edsair.pmid..........fc85f1e939dc08b77e45fe0c18e03567