New classification‐oriented treatment strategy for portal vein thrombosis after hepatectomy

Abstract

Aim This study sought to evaluate the incidence, risk factors, and clinical outcomes of portal vein thrombosis after hepatectomy. Furthermore, we proposed a novel classification and treatment strategy for portal vein thrombosis after hepatectomy. Methods We retrospectively analyzed 398 patients who underwent hepatectomy and enhanced computed tomography imaging within 14 days after surgery in our hospital from 2009 to 2019. Portal vein thrombosis was classified into three categories according to the location of the thrombus – main, hilar, and peripheral – with main portal vein thrombosis further subclassified into three grades. Each patient's treatment strategy was determined based on their portal vein thrombosis classification and grading. From 2015, enhanced computed tomography imaging was performed routinely on patients who underwent anatomical hepatectomy on postoperative day 7. Results Portal vein thrombosis was diagnosed in 57 patients (14.3%) during the study period. Multivariate analysis revealed that a Pringle maneuver time of 75 minutes or longer was a significant predictor of portal vein thrombosis ( P = .012). In total, 52 patients (91%) with portal vein thrombosis recovered by surgery, anticoagulant therapy, or without specific treatment. There was no instance of mortality recorded. Conclusions Patients who undergo hepatectomy are at high risk for portal vein thrombosis, especially when the Pringle maneuver time is long. The proposed classification and treatment strategy may be useful for clinical management of patients with portal vein thrombosis after hepatectomy.

Recurrent acute portal vein thrombosis with severe abdominal infection after right hemihepatectomy in a patient with perihilar cholangiocarcinoma: A case report and literature review

“…PVT is a rare and serious postoperative complication of liver resection. PVT is classified into three categories according to the location of the thrombus—main, hilar, and peripheral—with the main PVT further subclassified into three grades [10] . PVT frequently occurs following major hepatectomy, such as right hemihepatectomy [11] .…”

“…A high incidence of PVT has been found in hepatocellular carcinoma patients after hepatectomy. The frequency of the Pringle manoeuvre, especially when the Pringle manoeuvre time is long [10] , is a potential risk factor for postoperative PVT, and the postoperative/preoperative thrombin-antithrombin III (TAT) and D-dimer ratios may be used as early predictors of PVT after hepatectomy for hepatocellular carcinoma [17] .…”

“… Reference No. of patients Age Usage of prophylactic anti-coag Operational procedure Associated liver disease Time of PVT discovery (d) Location of PVT Treatment Mortality Risk factors Major hepatectomy Minor hepatectomy Cirrhosis Malignancy Hepatolithiasis Early Late MPV PPV MPV + PPV Stump (hilar) Surg Lytic Anti-coag 1 Yoshiya [12] et 19/208 66.7 ± 0.8 No 7 12 0 19 0 7 7 12 0 0 0 0 13 0 Right hepatectomy 2 Kuboki [10] et 25/1193 64.0 ± 1.5 (PVT)63.9 ± 0.4 (No PVT) No 18/446 7/747 4/25 24/25 0/25 n = 12 n = 13 5 3 17 0 9/11 0 12/14 2/25 Right-sided hepatectomy, caudate lobectomy, splenectomy, and postoperative bile leakage 3 Cao [18] et 6/177 68 (32–86) No 6 0 …”