Bridging and downstaging role of transarterial radioembolization (TARE) for expected small remnant volume after liver resection in hepatocellular carcinoma

Abstract

Introduction: Patients after liver surgery are classified into the high-risk group for deep vein thrombosis (DVT) and pulmonary embolism (PE) according to the Japanese guidelines. However, few reports have mentioned about pharmacologic thromboprophylaxis and postoperative thrombotic complications after liver surgery. Methods: From September 2015 to August 2017, 113 patients underwent postoperative pharmacologic thromboprophylaxis with enoxaparin after liver surgery. Of these, 60 patients with postoperative enhanced CT during the hospital stay were included and estimated about thrombotic complications.Results: The patients were 44 males and 16 females with a median age of 72 years. Enoxaparin was administered in 49 patients (82%), heparin in 1 patient (1.7%) and none in 10 patients (17%). 10 patients (17%) had postoperative thrombotic complications (DVT/PE in 1 patient, thrombosis of the internal jugular vein in 1 patient, inferior vena cava in 1 patient and portal vein in 7 patients) with no clinical symptoms. Postoperative pharmacologic thromboprophylaxis reduced thrombotic complications (P=0.083). On the other hand, 4 patients had adverse events (bleeding through placed abdominal drains in 3 patients, thrombocytopenia in 1 patient) and all were improved after stopping administration. Assessing perioperative factors, preoperative chemotherapy increased the risk (P=0.083) and preoperative serum albumin, intraoperative blood loss, postoperative total bilirubin were significantly higher (P=0.02/0.037/0.066) and prothrombin percentage activity was significantly lower (P=0.0006) in patients with thrombotic complications. Antithrombotic drugs were administered and thrombosis regressed in all complicated patients. Conclusion: Further investigation in more patients will reveal individual appropriate prevention and treatment for thrombotic complications after liver surgery.