Patterns of Improvement in Resection of Hepatocellular Carcinoma in Cirrhotic Patients: Results of a Non Drainage Policy

A prolonged ascitic leak through abdominal drains is a source of postoperative complications and of prolonged postoperative hospital stay after liver resection for hepatocellular carcinoma (HCC) in cirrhotic patients. Therefore we elected to abstain from routine abdominal drainage in the last 14 resections in cirrhotic livers. A significantly smaller number of patients had postoperative complications following liver resections without drainage (7%) than historical controls with abdominal drainage (59%, p < 0.01). The number of complications related to ascites was significantly greater in patients with abdominal drainage (76%) than without (0%, p < 0.001). Postoperative hospital stay was also significantly longer following resections with abdominal drainage (19 ± 4 days) than in patients without (12 ± 1 days, p < 0.01). The long postoperative hospital stay in patients with abdominal drainage was related to ascitic discharge for a mean period of 13 ± 10 days. No clinically significant accumulation of ascites was noted in patients without drainage. A more frequent utilization of hepatic vascular inflow occlusion did not account for the better results in the group of patients without drainage. These results suggest that routine abdominal drainage should not be used following liver resection for HCC in cirrhotic patients. This appears to be another of the technical details improving postoperative results in these patients.