Dr Takeaki Ishizawa and colleagues from Japan identified risk factors for a massive amount of ascites after liver resection to treat hepatocellular carcinoma.
In addition the research team postoperatively evaluated the management strategy by conducting a case-control study.
The team assessed 203 patients who underwent liver resection to treat hepatocellular carcinoma between 2003 and 2004.
The main outcome measures included the presence or absence of a large number of ascites.
Ascites was defined as postoperative daily ascitic fluid drainage exceeding 10 mL per kilogram of body weight, and operative morbidity, mortality, and treatment costs.
A large number of ascites developed in 15% of patients.
Multivariate analysis revealed that blood loss greater than 1000 mL, and preoperative platelet count less than 100 x 103/µL independently increased the risk of ascites.
In patients with ascites, urinary output on postoperative days 1 to 3 was significantly lower than in patients without ascites.
The research team noted that daily ascitic fluid volume tended to peak on postoperative day 7.
The team observed that no operative mortality was related to liver failure.
However, patients with ascites required a larger volume of fresh frozen plasma than those without ascites, 1600 mL vs 480 mL, resulting in higher hospital costs.
Dr Ishizawa’s concludes, “Large blood loss and low platelet count were independent risk factors for ascites.”
“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.”