Prospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. May 27, 2022; 14(5): 1016-1024
Published online May 27, 2022. doi: 10.4254/wjh.v14.i5.1016
Prospective validation to prevent symptomatic portal vein thrombosis after liver resection
Nao Yoshida, Shintaro Yamazaki, Moriguchi Masamichi, Yukiyasu Okamura, Tadatoshi Takayama
Nao Yoshida, Shintaro Yamazaki, Moriguchi Masamichi, Yukiyasu Okamura, Tadatoshi Takayama, Department of Digestive Surgery, Nihon University School of Medicine, Tokyo 1738610, Japan
Author contributions: Yoshida N collected the patient’s data; Yamazaki S designed this study; Masamichi M contributed to the proofreading of manuscript; Okamura Y and Takayama T supervised the writing of the manuscript.
Institutional review board statement: The ethics committee of Nihon University School of Medicine approved this clinical study.
Clinical trial registration statement: This study was registered in the UMIN Clinical Trials Registry under entry number UMIN000047362.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: Authors have no conflict-of-interest of this study.
Data sharing statement: Author can provide any data of this study.
CONSORT 2010 statement: The authors have read the CONSORT 2010 statement, and the manuscript was prepared and revised according to the CONSORT 2010 statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Shintaro Yamazaki, PhD, Associate Professor, Department of Digestive Surgery, Nihon University School of Medicine, 30-1 Ohyaguchi kami-mahi Itabashi-ku, Tokyo 1738610, Japan. yamazaki-nmed@umin.ac.jp
Received: March 26, 2021
Peer-review started: March 26, 2021
First decision: August 18, 2021
Revised: September 17, 2021
Accepted: May 8, 2022
Article in press: May 8, 2022
Published online: May 27, 2022
Abstract
BACKGROUND

Portal vein thrombosis (PVT) after liver resection is rare but can lead to life-threatening liver failure. This prospective study evaluated patients using contrast-enhanced computed tomography (E-CT) on the first day after liver resection for early PVT detection and management.

AIM

To evaluate patients by E-CT on the first day after liver resection for early PVT detection and immediate management.

METHODS

Patients who underwent liver resection for primary liver cancer from January 2015 were enrolled. E-CT was performed on the first day after surgery in patients undergoing anatomical resection, multiple resections, or with postoperative bile leakage in the high-risk group for PVT. When PVT was detected, anticoagulant therapy including heparin, warfarin, and edoxaban was administered. E-CT was performed monthly until PVT resolved.

RESULTS

The overall incidence of PVT was 1.57% (8/508). E-CT was performed on the first day after surgery in 235 consecutive high-risk patients (165 anatomical resections, 74 multiple resections, and 28 bile leakages), with a PVT incidence of 3.4% (8/235). Symptomatic PVT was not observed in the excluded cohort. Multivariate analyses revealed that sectionectomy was the only independent predictor of PVT [odds ratio (OR) = 12.20; 95% confidence interval (CI): 2.22-115.97; P = 0.003]. PVT was found in the umbilical portion of 75.0% (6/8) of patients, and sectionectomy on the left side showed the highest risk of PVT (OR = 14.10; 95%CI: 3.17-62.71; P < 0.0001).

CONCLUSION

Sectionectomy on the left side should be chosen with caution as it showed the highest risk of PVT. E-CT followed by anticoagulant therapy was effective in managing early-phase PVT for 2 mo without adverse events.

Keywords: Portal vein thrombosis, Liver resection, Anatomical resection, Anticoagulant therapy, Hepatocellular carcinoma, Umbilical potion

Core Tip: This prospective study evaluated patients by contrast-enhanced computed tomography (E-CT) on the first day after liver resection for early portal vein thrombosis (PVT) detection and immediate management. Sectionectomy on the left side should be treated with caution as it showed the highest risk of PVT. E-CT on the first day and immediate anticoagulant therapy were effective in managing early-phase PVT for 2 mo without adverse events.