The Impact of Postoperative Ascites on Survival After Surgery for Hepatocellular Carcinoma: a National Study.
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Famularo Simone, Donadon Matteo, Cipriani Federica, Ardito Francesco, Iaria Maurizio, Carissimi Francesca, Perri Pasquale, Dominioni Tommaso, Zanello Matteo, Conci Simone, Molfino Sarah, D'Acapito Fabrizio, Germani Paola, Ferrari Cecilia, Patauner Stefan, Pinotti Enrico, Sciannamea Ivano, Garatti Marco, Lodo Enrico, Troci Albert, Delvecchio Antonella, Floridi Antonio, Bernasconi Davide Paolo, Fumagalli Luca, Chiarelli Marco, Memeo Riccardo, Crespi Michele, Zanus Giacomo, Zimmitti Giuseppe, Antonucci Adelmo, Zago Mauro, Frena Antonio, Griseri Guido, Tarchi Paola, Ercolani Giorgio, Baiocchi Gian Luca, Ruzzenente Andrea, Jovine Elio, Maestri Marcello, Grazi GianLuca, Valle Raffaele Dalla, Giuliante Felice, Aldrighetti Luca, Romano Fabrizio, Torzilli Guido, HE.RC.O.LE.S. Group
Аннотация
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.