The Impact of Postoperative Ascites on Survival After Surgery for Hepatocellular Carcinoma: a National Study

Simone Famularo; Matteo Donadon; Federica Cipriani; Francesco Ardito; Maurizio Iaria; Francesca Carissimi; Pasquale Perri; Tommaso Dominioni; Matteo Zanello; Simone Conci; Sarah Molfino; Fabrizio D’Acapito; Paola Germani; Cecilia Ferrari; Stefan Patauner; Enrico Pinotti; Ivano Sciannamea; Marco Garatti; Enrico Lodo; Albert Troci; Antonella Delvecchio; Antonio Floridi; Davide Paolo Bernasconi; Luca Fumagalli; Marco Chiarelli; Riccardo Memeo; Michele Crespi; Giacomo Zanus; Giuseppe Zimmitti; Adelmo Antonucci; Mauro Zago; Antonio Frena; Guido Griseri; Paola Tarchi; Giorgio Ercolani; Gian Luca Baiocchi; Andrea Ruzzenente; Elio Jovine; Marcello Maestri; Gian Luca Grazi; Raffaele Dalla Valle; Felice Giuliante; Luca Aldrighetti; Fabrizio Romano; Guido Torzilli; Guido Costa; Cristina Ciulli; Alessandro Giani; Francesca Ratti; Manuela Bellobono; Elena Cremaschi; Maria Grazia Valsecchi; Valerio De Peppo; Francesco Calabrese; Giuseppina DeSario; Giovanni Lazzari; Alessandro Cucchetti; Davide Cosola; Andrea Percivale; Michele Ciola; Mauro Montuori; Silvia Frassani; Alberto Manzoni; Luca Salvador; Luca Pennacchi; Pio Corleone; Maria Conticchio

doi:10.1007/s11605-021-04952-z

The Impact of Postoperative Ascites on Survival After Surgery for Hepatocellular Carcinoma: a National Study

Simone Famularo, Matteo Donadon, Federica Cipriani, Francesco Ardito, Maurizio Iaria, Francesca Carissimi, Pasquale Perri, Tommaso Dominioni, Matteo Zanello, Simone Conci, Sarah Molfino, Fabrizio D’Acapito, Paola Germani, Cecilia Ferrari, Stefan Patauner, Enrico Pinotti, Ivano Sciannamea, Marco Garatti, Enrico Lodo, Albert TrociAntonella Delvecchio, Antonio Floridi, Davide Paolo Bernasconi, Luca Fumagalli, Marco Chiarelli, Riccardo Memeo, Michele Crespi, Giacomo Zanus, Giuseppe Zimmitti, Adelmo Antonucci, Mauro Zago, Antonio Frena, Guido Griseri, Paola Tarchi, Giorgio Ercolani, Gian Luca Baiocchi, Andrea Ruzzenente, Elio Jovine, Marcello Maestri, Gian Luca Grazi, Raffaele Dalla Valle, Felice Giuliante, Luca Aldrighetti, Fabrizio Romano, Guido Torzilli, Guido Costa, Cristina Ciulli, Alessandro Giani, Francesca Ratti, Manuela Bellobono, Elena Cremaschi, Maria Grazia Valsecchi, Valerio De Peppo, Francesco Calabrese, Giuseppina DeSario, Giovanni Lazzari, Alessandro Cucchetti, Davide Cosola, Andrea Percivale, Michele Ciola, Mauro Montuori, Silvia Frassani, Alberto Manzoni, Luca Salvador, Luca Pennacchi, Pio Corleone, Maria Conticchio

Risultato della ricerca: Contributo su rivista › Articolo in rivista › peer review

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.

Lingua originale	Inglese
pagine (da-a)	2823-2834
Numero di pagine	12
Rivista	Journal of Gastrointestinal Surgery
Volume	25
Numero di pubblicazione	11
DOI	https://doi.org/10.1007/s11605-021-04952-z
Stato di pubblicazione	Pubblicato - nov 2021
Pubblicato esternamente	Sì

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10.1007/s11605-021-04952-z

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Famularo, S., Donadon, M., Cipriani, F., Ardito, F., Iaria, M., Carissimi, F., Perri, P., Dominioni, T., Zanello, M., Conci, S., Molfino, S., D’Acapito, F., Germani, P., Ferrari, C., Patauner, S., Pinotti, E., Sciannamea, I., Garatti, M., Lodo, E., ... Conticchio, M. (2021). The Impact of Postoperative Ascites on Survival After Surgery for Hepatocellular Carcinoma: a National Study. Journal of Gastrointestinal Surgery, 25(11), 2823-2834. https://doi.org/10.1007/s11605-021-04952-z

@article{017286b1795d4c828cdba0bc8dd11540,

title = "The Impact of Postoperative Ascites on Survival After Surgery for Hepatocellular Carcinoma: a National Study",

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.",

keywords = "Disease-free survival, Hepatocellular carcinoma, Liver surgery, Overall survival, Postoperative ascites, Postoperative complications",

author = "Simone Famularo and Matteo Donadon and Federica Cipriani and Francesco Ardito and Maurizio Iaria and Francesca Carissimi and Pasquale Perri and Tommaso Dominioni and Matteo Zanello and Simone Conci and Sarah Molfino and Fabrizio D{\textquoteright}Acapito and Paola Germani and Cecilia Ferrari and Stefan Patauner and Enrico Pinotti and Ivano Sciannamea and Marco Garatti and Enrico Lodo and Albert Troci and Antonella Delvecchio and Antonio Floridi and Bernasconi, \{Davide Paolo\} and Luca Fumagalli and Marco Chiarelli and Riccardo Memeo and Michele Crespi and Giacomo Zanus and Giuseppe Zimmitti and Adelmo Antonucci and Mauro Zago and Antonio Frena and Guido Griseri and Paola Tarchi and Giorgio Ercolani and Baiocchi, \{Gian Luca\} and Andrea Ruzzenente and Elio Jovine and Marcello Maestri and Grazi, \{Gian Luca\} and Valle, \{Raffaele Dalla\} and Felice Giuliante and Luca Aldrighetti and Fabrizio Romano and Guido Torzilli and Guido Costa and Cristina Ciulli and Alessandro Giani and Francesca Ratti and Manuela Bellobono and Elena Cremaschi and Valsecchi, \{Maria Grazia\} and \{De Peppo\}, Valerio and Francesco Calabrese and Giuseppina DeSario and Giovanni Lazzari and Alessandro Cucchetti and Davide Cosola and Andrea Percivale and Michele Ciola and Mauro Montuori and Silvia Frassani and Alberto Manzoni and Luca Salvador and Luca Pennacchi and Pio Corleone and Maria Conticchio",

note = "Publisher Copyright: {\textcopyright} 2021, The Society for Surgery of the Alimentary Tract.",

year = "2021",

month = nov,

doi = "10.1007/s11605-021-04952-z",

language = "English",

volume = "25",

pages = "2823--2834",

journal = "Journal of Gastrointestinal Surgery",

issn = "1091-255X",

publisher = "Society for Surgery of the Alimentary Tract",

number = "11",

}

Famularo, S, Donadon, M, Cipriani, F, Ardito, F, Iaria, M, Carissimi, F, Perri, P, Dominioni, T, Zanello, M, Conci, S, Molfino, S, D’Acapito, F, Germani, P, Ferrari, C, Patauner, S, Pinotti, E, Sciannamea, I, Garatti, M, Lodo, E, Troci, A, Delvecchio, A, Floridi, A, Bernasconi, DP, Fumagalli, L, Chiarelli, M, Memeo, R, Crespi, M, Zanus, G, Zimmitti, G, Antonucci, A, Zago, M, Frena, A, Griseri, G, Tarchi, P, Ercolani, G, Baiocchi, GL, Ruzzenente, A, Jovine, E, Maestri, M, Grazi, GL, Valle, RD, Giuliante, F, Aldrighetti, L, Romano, F, Torzilli, G, Costa, G, Ciulli, C, Giani, A, Ratti, F, Bellobono, M, Cremaschi, E, Valsecchi, MG, De Peppo, V, Calabrese, F, DeSario, G, Lazzari, G, Cucchetti, A, Cosola, D, Percivale, A, Ciola, M, Montuori, M, Frassani, S, Manzoni, A, Salvador, L, Pennacchi, L, Corleone, P & Conticchio, M 2021, 'The Impact of Postoperative Ascites on Survival After Surgery for Hepatocellular Carcinoma: a National Study', Journal of Gastrointestinal Surgery, vol. 25, n. 11, pagg. 2823-2834. https://doi.org/10.1007/s11605-021-04952-z

TY - JOUR

T1 - The Impact of Postoperative Ascites on Survival After Surgery for Hepatocellular Carcinoma

T2 - a National Study

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 - Bellobono, Manuela

AU - Cremaschi, Elena

AU - Valsecchi, Maria Grazia

AU - De Peppo, Valerio

AU - Calabrese, Francesco

AU - DeSario, Giuseppina

AU - Lazzari, Giovanni

AU - Cucchetti, Alessandro

AU - Cosola, Davide

AU - Percivale, Andrea

AU - Ciola, Michele

AU - Montuori, Mauro

AU - Frassani, Silvia

AU - Manzoni, Alberto

AU - Salvador, Luca

AU - Pennacchi, Luca

AU - Corleone, Pio

AU - Conticchio, Maria

PY - 2021/11

Y1 - 2021/11

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

UR - https://www.scopus.com/pages/publications/85102391371

U2 - 10.1007/s11605-021-04952-z

DO - 10.1007/s11605-021-04952-z

M3 - Article

SN - 1091-255X

VL - 25

SP - 2823

EP - 2834

JO - Journal of Gastrointestinal Surgery

JF - Journal of Gastrointestinal Surgery

IS - 11

ER -

The Impact of Postoperative Ascites on Survival After Surgery for Hepatocellular Carcinoma: a National Study

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