Annals of Surgical Oncology

, Volume 23, Issue 11, pp 3727–3735 | Cite as

A Randomized Clinical Trial of Preoperative Administration of Branched-Chain Amino Acids to Prevent Postoperative Ascites in Patients with Liver Resection for Hepatocellular Carcinoma

  • Yutaro Kikuchi
  • Yukihiko Hiroshima
  • Kenichi Matsuo
  • Daisuke Kawaguchi
  • Takashi Murakami
  • Yasuhiro Yabushita
  • Itaru Endo
  • Masataka Taguri
  • Keiji Koda
  • Kuniya TanakaEmail author
Hepatobiliary Tumors



Massive postoperative ascites remains a major threat that can lead to liver failure and other fatal complications, especially in patients with poor liver function. Branched-chain amino acid (BCAA) administration increases biosynthesis and secretion of albumin by hepatocytes and increases oncotic pressure by elevating blood albumin concentration, thereby decreasing peripheral edema, ascites, and pleural effusion.


We randomly allocated consecutive patients undergoing major liver resection for hepatocellular carcinoma to either a group where oral BCAA administration was initiated 3 weeks before liver resection, or a non-BCAA group. The primary study endpoint was development of postoperative ascites.


Overall, 39 patients were allocated to the BCAA group, while 38 were assigned to the non-BCAA group. No significant difference in the rate of refractory ascites, considered alone, was evident between the BCAA (5.1 %) and non-BCAA groups (13.2 %; p = 0.263). However, the occurrence of refractory ascites and/or pleural effusion was significantly less frequent in the BCAA group (5.1 %) than in the non-BCAA group (21.1 %; p = 0.047). Furthermore, the postoperative serum concentration of reduced-state albumin was greater immediately after liver resection in the BCAA group than in the non-BCAA group.


Preoperative administration of BCAA did not significantly improve prevention of refractory ascites, but significant effectiveness in preventing ascites, pleural effusion, or both, as well as improving metabolism of albumin, was demonstrated [University Hospital Medical Information Network (UMIN) reference number 000004244].


Liver Resection Prognostic Nutritional Index Serum Albumin Concentration Refractory Ascites BCAA Supplementation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



This study was supported in part by the Japan Society for the Promotion of Science (JSPS) KAKENHI Grant numbers 26830081 to Yukihiko Hiroshima and 24592009 to Kuniya Tanaka.


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Copyright information

© Society of Surgical Oncology 2016

Authors and Affiliations

  • Yutaro Kikuchi
    • 1
  • Yukihiko Hiroshima
    • 1
  • Kenichi Matsuo
    • 1
  • Daisuke Kawaguchi
    • 1
  • Takashi Murakami
    • 1
  • Yasuhiro Yabushita
    • 2
  • Itaru Endo
    • 2
  • Masataka Taguri
    • 3
  • Keiji Koda
    • 1
  • Kuniya Tanaka
    • 1
    • 2
    Email author
  1. 1.Department of SurgeryTeikyo University Chiba Medical CenterChibaJapan
  2. 2.Department of Gastroenterological SurgeryYokohama City University Graduate School of MedicineYokohamaJapan
  3. 3.Department of Biostatistics and EpidemiologyYokohama City University Graduate School of MedicineYokohamaJapan

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