Hyaluronic Acid Predicts Postoperative Large Amount of Ascites after Liver Resection for Patients with Hepatocellular Carcinoma

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Postoperative large amount of ascites (PLA) is a postoperative complication in patients undergoing liver resection (LR) for hepatocellular carcinoma (HCC) and can lead to poor prognosis. The purpose of this study is to investigate predictor and prognosis of patients with PLA.


Four hundred HCC patients undergoing LR were divided into 2 groups: Group A, patients without PLA; Group B, patients with PLA. Statistical analysis was performed to assess the clinical features associated with PLA and to compare the survival between Groups A and B.


Multivariate analysis revealed that body mass index (≤22 kg/m2), albumin (≤3.5 g/dl), hyaluronic acid (HA; >200 ng/ml), bleeding (>620 ml) and total intraoperative in-out balance (>5.0 ml/kg/h) were associated with PLA. HA (>200 ng/ml) was the most useful predictor of PLA, because the area under the receiver operating characteristic curve of HA was the highest among these 5 features. The relapse-free, cancer-specific and overall survival rates were poorer in Group B than in Group A.


The serum HA level (>200 ng/ml) is a useful predictor of PLA in HCC patients undergoing LR. As PLA leads to poor prognosis, the surgical method for HCC patients with an elevated serum HA level should be carefully considered.

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