Background: Ascites is one of the most common complications after liver resection. Although it is not generally considered to be an expression of postoperative liver failure, it is commonly associated with an increased rate of postoperative mortality. Objective: We evaluated the predictive factors and the clinical relevance of postoperative ascites, both for early and long-term results, using actuarial and actual long-term survival analysis. Materials and methods: A retrospective evaluation of 325 unselected and consecutive patients who received liver resection with hepatocellular carcinoma (HCC) was carried out. Overall survival and disease-free survival according to the occurrence of postoperative ascites were computed. Results: No features linked to the technical aspect of the resection had a predictive value. The only feature related to the tumor was the posterior location of HCC. In the subgroup of cirrhotic patients with a posterior-side HCC, the rate of ascites was 34.9%; 51 out of 57 patients with ascites (89.5%) presented a posteriorly located HCC in cirrhosis. Roughly one-fifth of patients with postoperative ascites presented signs of liver failure, but in-hospital mortality was almost four-fold that of patients without ascites. Conclusion: A posterior location of HCC significantly increased the risk of ascites.
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