TY - JOUR
T1 - The Impact of Postoperative Ascites on Survival After Surgery for Hepatocellular Carcinoma
T2 - a National Study
AU - HE.RC.O.LE.S. Group
AU - Famularo, Simone
AU - Donadon, Matteo
AU - Cipriani, Federica
AU - Ardito, Francesco
AU - Iaria, Maurizio
AU - Carissimi, Francesca
AU - Perri, Pasquale
AU - Dominioni, Tommaso
AU - Zanello, Matteo
AU - Conci, Simone
AU - Molfino, Sarah
AU - D’Acapito, Fabrizio
AU - Germani, Paola
AU - Ferrari, Cecilia
AU - Patauner, Stefan
AU - Pinotti, Enrico
AU - Sciannamea, Ivano
AU - Garatti, Marco
AU - Lodo, Enrico
AU - Troci, Albert
AU - Delvecchio, Antonella
AU - Floridi, Antonio
AU - Bernasconi, Davide Paolo
AU - Fumagalli, Luca
AU - Chiarelli, Marco
AU - Memeo, Riccardo
AU - Crespi, Michele
AU - Zanus, Giacomo
AU - Zimmitti, Giuseppe
AU - Antonucci, Adelmo
AU - Zago, Mauro
AU - Frena, Antonio
AU - Griseri, Guido
AU - Tarchi, Paola
AU - Ercolani, Giorgio
AU - Baiocchi, Gian Luca
AU - Ruzzenente, Andrea
AU - Jovine, Elio
AU - Maestri, Marcello
AU - Grazi, Gian Luca
AU - Valle, Raffaele Dalla
AU - Giuliante, Felice
AU - Aldrighetti, Luca
AU - Romano, Fabrizio
AU - Torzilli, Guido
AU - Costa, Guido
AU - Ciulli, Cristina
AU - Giani, Alessandro
AU - Ratti, Francesca
AU - Torzilli, Guido
N1 - Publisher Copyright:
© 2021, The Society for Surgery of the Alimentary Tract.
PY - 2021
Y1 - 2021
N2 - Background: 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. Method: 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. Results: 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 (p < 0.001). POA independently increased the risk of mortality (HR = 1.696, 95%CI = 1.352–2.129, p < 0.001). Relapse risk after surgery was not predicted by the occurrence of POA. Presence of varices (OR = 2.562, 95%CI = 0.921–1.822, p < 0.001) 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, p < 0.001). Ninety-day mortality was higher in the POA group (9.1% vs 1.9% in NO-POA group, p < 0.001). Conclusion: 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.
AB - Background: 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. Method: 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. Results: 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 (p < 0.001). POA independently increased the risk of mortality (HR = 1.696, 95%CI = 1.352–2.129, p < 0.001). Relapse risk after surgery was not predicted by the occurrence of POA. Presence of varices (OR = 2.562, 95%CI = 0.921–1.822, p < 0.001) 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, p < 0.001). Ninety-day mortality was higher in the POA group (9.1% vs 1.9% in NO-POA group, p < 0.001). Conclusion: 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.
KW - Disease-free survival
KW - Hepatocellular carcinoma
KW - Liver surgery
KW - Overall survival
KW - Postoperative ascites
KW - Postoperative complications
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U2 - 10.1007/s11605-021-04952-z
DO - 10.1007/s11605-021-04952-z
M3 - Article
AN - SCOPUS:85102391371
JO - Journal of Gastrointestinal Surgery
JF - Journal of Gastrointestinal Surgery
SN - 1091-255X
ER -