Intractable ascites following surgery for gastric carcinoma

Over the past 11 years, I have experienced a few patients with intractable ascites after extended radical surgery for gastric carcinomas, which accounted for 1.0% (4 of 394) of all gastric carcinomas resected in our institute. These 4 patients underwent total or subtotal gastrectomy with extended lymphadenectomy, including the lymph nodes of the hepatoduodenal ligament. Histopathologic examination of an intraoperative liver biopsy specimen revealed chronic hepatitis or liver cirrhosis. The characteristics of the ascites led me to conclude that the ascites comprised liver lymphatic fluid. Surgeons must recognize that intractable ascites due to leakage of liver lymphatic fluid after gastrectomy with extended lymphadenectomy is likely to occur in patients with chronic hepatitis or liver cirrhosis.