Risk factors and management of ascites after liver resection to treat hepatocellular carcinoma

Objectives: To identify risk factors for a massive amount of ascites after liver resection to treat hepatocellular carcinoma and to evaluate our postoperative management strategy. Design: Case-control study. Setting: University hospital. Patients: Two hundred three patients who underwent liver resection to treat hepatocellular carcinoma between January 1, 2003, and December 31, 2004. Main Outcome Measures: Presence or absence of a large number of ascites (LA), defined as postoperative daily ascitic fluid drainage exceeding 10 mL per kilogram of body weight, and operative morbidity, mortality, and treatment costs. Results: A large number of ascites developed in 31 patients (15%). Multivariate analysis revealed that blood loss greater than 1000 mL (relative risk, 6.38; 95% confidence interval, 2.19-20.7; P=.001) and preoperative platelet count less than 100 × 10³/μL (4.75; 1.75-13.1; P=.002) independently increased the risk of LA. In patients with LA, urinary output on postoperative days 1 to 3 was significantly lower than in patients without LA, and daily ascitic fluid volume tended to peak on postoperative day 7. No operative mortality was related to liver failure; however, patients with LA required a larger volume of fresh frozen plasma than those without LA (median [range], 1600 [0-16 800] mL vs 480 [0-5760] mL; P<.001), resulting in higher hospital costs. Conclusions: Large blood loss and low platelet count were independent risk factors for LA. Although it was possible to safely manage postoperative ascites using routine administration of diuretic agents and fresh frozen plasma, step-by-step trials are required to reduce the need for transfusion of fresh frozen plasma.