Skip to main content
SpringerLink
Log in

Portal Vein Thrombosis After Hepatectomy

  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

Although various complications after hepatectomy have been reported, there have been no large studies on postoperative portal vein thrombosis (PVT) as a complication. This study evaluated the incidence, risk factors, and clinical outcomes of PVT after hepatectomy.

Methods

The preoperative and postoperative clinical characteristics of patients who underwent hepatectomy were retrospectively analyzed.

Results

A total of 208 patients were reviewed. The incidence of PVT after hepatectomy was 9.1 % (n = 19), including main portal vein (MPV) thrombosis (n = 7) and peripheral portal vein (PPV) thrombosis (n = 12). Patients with MPV thrombosis had a significantly higher incidence of right hepatectomy (p < 0.001), larger resection volume (p = 0.003), and longer operation time (p = 0.021) than patients without PVT (n = 189). Multivariate analysis identified right hepatectomy as a significant independent risk factor for MPV thrombosis (odds ratio 108.9; p < 0.001). Patients with PPV thrombosis had a significantly longer duration of Pringle maneuver than patients without PVT (p = 0.002). Among patients who underwent right hepatectomy, those with PVT (n = 6) had a significantly lower early liver regeneration rate than those without PVT (n = 13; p = 0.040), and those with PVT had deterioration of liver function on postoperative day 7. In all patients with MPV thrombosis who received anticoagulation therapy, PVT subsequently resolved.

Conclusions

Postoperative PVT after hepatectomy is not rare. It is closely related to delayed recovery of liver function and delayed liver regeneration.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Kanematsu T, Matsumata T, Shirabe K et al (1993) A comparative study of hepatic resection and transcatheter arterial embolization for the treatment of primary hepatocellular carcinoma. Cancer 171:2181–2186

    Article  Google Scholar 

  2. Fong Y, Fortner J, Sun RL et al (1999) Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg 230:309–318 (discussion 318–321)

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  3. Taketomi A, Kitagawa D, Itoh S et al (2007) Trends in morbidity and mortality after hepatic resection for hepatocellular carcinoma: an institute’s experience with 625 patients. J Am Coll Surg 204:580–587

    Article  PubMed  Google Scholar 

  4. Chen H, Qi X, He C et al (2013) Coagulation imbalance may not contribute to the development of portal vein thrombosis in patients with cirrhosis. Thromb Res 131:173–177

    Article  CAS  PubMed  Google Scholar 

  5. Zocco MA, Di Stasio E, De Cristofaro R et al (2009) Thrombotic risk factors in patients with liver cirrhosis: correlation with MELD scoring system and portal vein thrombosis development. J Hepatol 51:682–689

    Article  PubMed  Google Scholar 

  6. Thomas RM, Ahmad SA (2010) Management of acute post-operative portal venous thrombosis. J Gastrointest Surg 14:570–577

    Article  PubMed  Google Scholar 

  7. Rahbari NN, Garden OJ, Padbury R et al (2011) Posthepatectomy liver failure: a definition and grading by the International Study Group of Liver Surgery (ISGLS). Surgery 149:713–724

    Article  PubMed  Google Scholar 

  8. Koch M, Garden OJ, Padbury R et al (2011) Bile leakage after hepatobiliary and pancreatic surgery: a definition and grading of severity by the International Study Group of Liver Surgery. Surgery 19:680–688

    Article  Google Scholar 

  9. Nobili C, Marzano E, Oussoultzoglou E et al (2012) Multivariate analysis of risk factors for pulmonary complications after hepatic resection. Ann Surg 255:540–550

    Article  PubMed  Google Scholar 

  10. Harada N, Shirabe K, Ijichi H et al (2012) Acoustic radiation force impulse imaging predicts postoperative ascites resulting from curative hepatic resection for hepatocellular carcinoma. Surgery 151:837–843

    Article  PubMed  Google Scholar 

  11. Turley RS, Reddy SK, Shortell CK et al (2012) Venous thromboembolism after hepatic resection: analysis of 5,706 patients. J Gastrointest Surg 16:1705–1714

    Article  PubMed  Google Scholar 

  12. Ikeda T, Mano Y, Morita K et al (2013) Pure laparoscopic hepatectomy in semiprone position for right hepatic major resection. J Hepatobiliary Pancreat Sci 20:145–150

    Article  PubMed Central  PubMed  Google Scholar 

  13. Ikeda T, Yonemura Y, Ueda N et al (2011) Pure laparoscopic right hepatectomy in the semi-prone position using the intrahepatic Glissonian approach and a modified hanging maneuver to minimize intraoperative bleeding. Surg Today 41:1592–1598

    Article  PubMed  Google Scholar 

  14. Fukuhara T, Umeda K, Toshima T et al (2009) Congestion of the donor remnant right liver after extended left lobe donation. Transpl Int 22:837–844

    Article  PubMed  Google Scholar 

  15. Kayashima H, Shirabe K, Morita K et al (2012) Liver regeneration and venous collateral formation in the right lobe living-donor remnant: segmental volumetric analysis and three-dimensional visualization. Transplantation 95:353–360

    Article  Google Scholar 

  16. Bach AM, Hann LE, Brown KT et al (1996) Portal vein evaluation with US: comparison to angiography combined with CT arterial portography. Radiology 201:149–154

    CAS  PubMed  Google Scholar 

  17. Klempnauer J, Grothues F, Bektas H et al (1997) Results of portal thrombectomy and splanchnic thrombolysis for the surgical management of acute mesentericoportal thrombosis. Br J Surg 84:129–132

    Article  CAS  PubMed  Google Scholar 

  18. Kobayashi S, Yokoyama Y, Matsushita T et al (2012) Increased von Willebrand factor to ADAMTS13 ratio as a predictor of thrombotic complications following a major hepatectomy. Arch Surg 147:909–917

    Article  PubMed  Google Scholar 

  19. Zappa M, Dondero F, Sibert A et al (2009) Liver regeneration at day 7 after right hepatectomy: global and segmental volumetric analysis by using CT. Radiology 252:426–432

    PubMed  Google Scholar 

  20. Kele PG, de Boer M, van der Jagt EJ et al (2012) Early hepatic regeneration index and completeness of regeneration at 6 months after partial hepatectomy. Br J Surg 99:1113–1119

    Article  CAS  PubMed  Google Scholar 

  21. Marubashi S, Sakon M, Nagano H et al (2004) Effect of portal hemodynamics on liver regeneration studied in a novel portohepatic shunt rat model. Surgery 136:1028–1037

    Article  PubMed  Google Scholar 

  22. Wu TJ, Dahiya D, Lee CS et al (2011) Impact of portal venous hemodynamics on indices of liver function and graft regeneration after right lobe living donor liver transplantation. Liver Transplant 17:1035–1045

    Google Scholar 

  23. Abshagen K, Eipel C, Vollmar B (2012) A critical appraisal of the hemodynamic signal driving liver regeneration. Langenbecks Arch Surg 397:579–590

    Article  PubMed  Google Scholar 

  24. Yoshiya S, Shirabe K, Kimura K et al (2012) The causes, risk factors, and outcomes of early relaparotomy after living-donor liver transplantation. Transplantation 94:947–952

    Article  PubMed  Google Scholar 

  25. Luca A, Caruso S, Milazzo M et al (2012) Natural course of extrahepatic nonmalignant partial portal vein thrombosis in patients with cirrhosis. Radiology 265:124–132

    Article  PubMed  Google Scholar 

  26. Senzolo M, Sartori MT, Rossetto V et al (2012) Prospective evaluation of anticoagulation and transjugular intrahepatic portosystemic shunt for the management of portal vein thrombosis in cirrhosis. Liver Int 32:919–927

    Article  CAS  PubMed  Google Scholar 

  27. Plessier A, Darwish-Murad S, Hernandez-Guerra M et al (2010) Acute portal vein thrombosis unrelated to cirrhosis: a prospective multicenter follow-up study. Hepatology 51:210–218

    Article  PubMed  Google Scholar 

  28. Turnes J, Garcia-Pagan JC, Gonzalez M et al (2008) Portal hypertension-related complications after acute portal vein thrombosis: impact of early anticoagulation. Clin Gastroenterol Hepatol 6:1412–1417

    Article  PubMed  Google Scholar 

  29. Plessier A, Rautou PE, Valla DC (2012) Management of hepatic vascular diseases. J Hepatol 56(Suppl 1):S25–S38

    Article  CAS  PubMed  Google Scholar 

  30. Huard G, Bilodeau M (2012) Management of anticoagulation for portal vein thrombosis in individuals with cirrhosis: a systematic review. Int J Hepatol 2012:672986. doi:10.1155/2012/672986

    PubMed Central  PubMed  Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan

    Shohei Yoshiya, Ken Shirabe, Hidekazu Nakagawara, Yuji Soejima, Tomoharu Yoshizumi, Toru Ikegami, Yo-ichi Yamashita, Norifumi Harimoto & Yoshihiko Maehara

  2. Department of Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

    Akihiro Nishie

  3. Biostatistics Section, Research Center for Innovative Oncology, National Cancer Hospital East, Chiba, Japan

    Takeharu Yamanaka

Authors
  1. Shohei Yoshiya
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ken Shirabe
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hidekazu Nakagawara
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yuji Soejima
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tomoharu Yoshizumi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Toru Ikegami
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yo-ichi Yamashita
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Norifumi Harimoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Akihiro Nishie
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Takeharu Yamanaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Yoshihiko Maehara
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ken Shirabe.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Yoshiya, S., Shirabe, K., Nakagawara, H. et al. Portal Vein Thrombosis After Hepatectomy. World J Surg 38, 1491–1497 (2014). https://doi.org/10.1007/s00268-013-2440-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-013-2440-8

Keywords

Search

Navigation