Simone Famularo1,2, Matteo Donadon3, Federica Cipriani4, Francesco Ardito5, Maurizio Iaria6, Francesca Carissimi7,8, Pasquale Perri9, Tommaso Dominioni10, Matteo Zanello11, Simone Conci12, Sarah Molfino13, Fabrizio D'Acapito14, Paola Germani15, Cecilia Ferrari16, Stefan Patauner17, Enrico Pinotti18, Ivano Sciannamea19, Marco Garatti20, Enrico Lodo21, Albert Troci22, Antonella Delvecchio23, Antonio Floridi24, Davide Paolo Bernasconi25, Luca Fumagalli26, Marco Chiarelli26, Riccardo Memeo23, Michele Crespi22, Giacomo Zanus21, Giuseppe Zimmitti20, Adelmo Antonucci19, Mauro Zago26, Antonio Frena17, Guido Griseri16, Paola Tarchi15, Giorgio Ercolani14, Gian Luca Baiocchi13, Andrea Ruzzenente12, Elio Jovine11, Marcello Maestri10, GianLuca Grazi9, Raffaele Dalla Valle6, Felice Giuliante5, Luca Aldrighetti4, Fabrizio Romano7,8, Guido Torzilli3. 1. School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy. simone.famularo@gmail.com. 2. Hepatobiliary and General Surgery Division, Department of Biomedical Science, Humanitas University, Humanitas Clinical and Research Center - IRCCS, Via Alessandro Manzoni 56, 20089, Rozzano, Milan, Italy. simone.famularo@gmail.com. 3. Hepatobiliary and General Surgery Division, Department of Biomedical Science, Humanitas University, Humanitas Clinical and Research Center - IRCCS, Via Alessandro Manzoni 56, 20089, Rozzano, Milan, Italy. 4. Hepatobiliary Surgery Division, Ospedale San Raffaele, Milano, Italy. 5. Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Catholic University of the Sacred Heart, Rome, Italy. 6. Department of Medicine and Surgery, University of Parma, Parma, Italy. 7. School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy. 8. HPB Unit, Department of Surgery, San Gerardo Hospital, Monza, Italy. 9. Division of Hepatobiliarypancreatic Unit, IRCCS - Regina Elena National Cancer Institute, Rome, Italy. 10. Unit of General Surgery 1, University of Pavia and Foundation IRCCS Policlinico San Matteo, Pavia, Italy. 11. Department of Surgery, AOU Sant'Orsola Malpighi, IRCCS, Bologna, Italy. 12. Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy. 13. Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy. 14. General and Oncologic Surgery, Morgagni-Pierantoni Hospital, Forlì, Italy. 15. Surgical Clinic, University Hospital of Trieste, Trieste, Italy. 16. HPB Surgical Unit, San Paolo Hospital, Savona, Italy. 17. Department of Surgery, Bolzano Central Hospital, Bolzano, Italy. 18. Department of Surgery, Ponte San Pietro Hospital, Bergamo, Italy. 19. Department of Surgery, Monza Policlinic, Monza, Italy. 20. Department of General Surgery, Poliambulanza Foundation Hospital, Brescia, Italy. 21. Department of Surgical, Oncological and Gastroenterological Science (DISCOG), University of Padua, Hepatobiliary and Pancreatic Surgery Unit - Treviso Hospital, Treviso, Italy. 22. Department of Surgery, L. Sacco Hospital, Milan, Italy. 23. Department of Hepato-Pancreatic-Biliary Surgery, Miulli Hospital, Bari, Italy. 24. Department of General Surgery, ASST Crema, Crema, Italy. 25. Center of Biostatistics for Clinical Epidemiology, School of Medicine and Surgery, University of Milan - Bicocca, Monza, Italy. 26. Department of Emergency and Robotic Surgery, ASST Lecco, Lecco, Italy.
Abstract
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.
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.
Authors: Pierre A Clavien; Jeffrey Barkun; Michelle L de Oliveira; Jean Nicolas Vauthey; Daniel Dindo; Richard D Schulick; Eduardo de Santibañes; Juan Pekolj; Ksenija Slankamenac; Claudio Bassi; Rolf Graf; René Vonlanthen; Robert Padbury; John L Cameron; Masatoshi Makuuchi Journal: Ann Surg Date: 2009-08 Impact factor: 12.969
Authors: G Fernández-Esparrach; A Sánchez-Fueyo; P Ginès; J Uriz; L Quintó; P J Ventura; A Cárdenas; M Guevara; P Sort; W Jiménez; R Bataller; V Arroyo; J Rodés Journal: J Hepatol Date: 2001-01 Impact factor: 25.083
Authors: Roberto Santambrogio; Michael D Kluger; Mara Costa; Andrea Belli; Matteo Barabino; Alexis Laurent; Enrico Opocher; Daniel Azoulay; Daniel Cherqui Journal: HPB (Oxford) Date: 2012-10-24 Impact factor: 3.647
Authors: Cécile Skrzypczyk; Stéphanie Truant; Alain Duhamel; Carole Langlois; Emmanuel Boleslawski; Dine Koriche; Mohamed Hebbar; François Fourrier; Philippe Mathurin; François René Pruvot Journal: Ann Surg Date: 2014-11 Impact factor: 12.969