Published online May 27, 2022. doi: 10.4254/wjh.v14.i5.1016
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
Processing time: 423 Days and 23.6 Hours
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.
To evaluate patients by E-CT on the first day after liver resection for early PVT detection and immediate management.
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.
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).
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.
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.