Blood Loss, Low Platelet Count Increase Risk of Ascites After Liver Resection

NEW YORK (Reuters Health) Feb 06 - Extensive blood loss and low platelet counts increase the risk of massive ascites after liver resection for hepatocellular carcinoma (HCC), according to a report from Japan in the January issue of the Archives of Surgery.

"Routine administration of diuretic agents and, when necessary, unhesitating use of fresh frozen plasma (FFP) are useful in avoiding postoperative liver failure in cirrhotic patients with large amount of ascites," Dr. Takeaki Ishizawa told Reuters Health.

Dr. Ishizawa and colleagues from the Graduate School of Medicine, University of Tokyo, sought to identify risk factors for massive ascites after liver resection for HCC and to evaluate its postoperative management.

Patients who developed massive ascites had greater blood loss, were more likely to receive red blood cell transfusions, and required larger volumes of intraoperative FFP than did patients without massive ascites, the authors report.

In multivariate analysis, blood loss greater than 1000 mL and preoperative platelet count below 100,000 per microliter were independent risk factors for massive ascites.

Perioperative diuretic and FFP use were higher in the massive ascites group, and the total volume of postoperative FFP transfusion was larger in the massive ascites group than in the group without massive ascites.

Apart from a higher incidence of pleural effusion in the massive ascites group, the researchers note, postoperative morbidity was similar in the two groups.

Times to removal of abdominal drains, duration of postoperative hospital stay, total hospital costs, and transfusion costs were all higher in the massive ascites group than in the group without massive ascites, the investigators say.

"Recently, we have managed postoperative ascites using routine administration of diuretic agents and autologous FFP transfusion," Dr. Ishizawa said.

"We are now conducting further work to evaluate efficacy of autologous FFP transfusion in avoiding allogeneic blood products in the management after liver resection for HCC," Dr. Ishizawa added.

Arch Surg 2009;144:46-51.