Incidence, risk factors and outcomes for post-hepatectomy portal vein thrombosis: A retrospective study

Table 1 Clinical characteristics of the study population, n (%)

Characteristics	Overall (n = 1064)
Age
< 60	558 (52.4)
≥ 60	506 (47.6)
Gender
Male	660 (62)
Female	404 (38)
BMI, median (IQR)	23.24 (21.22, 25.38)
Diseases
Biliary tract cancer	362 (34)
Hepatocellular carcinoma	338 (31.8)
Benign disease	301 (28.3)
Other malignant disease	63 (5.9)
Liver cirrhosis
Yes	381 (35.8)
No	683 (64.2)
Major hepatectomy
Yes	594 (55.8)
No	470 (44.2)
Caudate lobectomy
Yes	266 (25)
No	798 (75)
Pancreaticoduodenectomy
Yes	11 (1)
No	1053 (99)
Portal vein reconstruction
Yes	90 (8.5)
No	974 (91.5)
Hepatic vein reconstruction
Yes	9 (0.8)
No	1055 (99.2)
Bile duct resection
Yes	390 (36.7)
No	674 (63.3)
Operation time (minute), median (IQR)	476 (328.75, 648)
Blood loss (mL), median (IQR)	300 (100, 500)
Blood transfusion
Yes	516 (48.5)
No	548 (51.5)
Postoperative portal vein angle
≥ 100	403 (68.1)
< 100	189 (31.9)
Main portal vein diameter (mm), median (IQR)	11 (9, 12)
Pringle maneuver time (minute), median (IQR)	56.18 (34.19, 84.27)
Preoperative laboratory test
Platelet count (9 × 104/μL), median (IQR)	195 (145, 260)
PTINR, median (IQR)	1.03 (0.97, 1.09)
FDP (μg/mL), median (IQR)	2.50 (2.50, 2.63)
D-dimer (μg/mL), median (IQR)	0.38 (0.15, 0.88)
Postoperative laboratory test
Platelet count (9 × 104/μL), median (IQR)	157 (110, 209.25)
PTINR, median (IQR)	1.16 (1.08, 1.26)
FDP (μg/mL), median (IQR)	22.46 (13.35, 34.03)
D-dimer (μg/mL), median (IQR)	8.20 (5.72, 13.08)

PTINR: Prothrombin time-international normalized ratio; FDP: Fibrinogen degradation product; BMI: Body mass index; IQR: Interquartile range.

Table 2 Comparison of clinical characteristics between post-hepatectomy portal vein thrombosis group and none post-hepatectomy portal vein thrombosis group

Characteristics	PH-PVT	Non-PH-PVT	P value	Method
n	42	1022
Age (n)			0.534	χ2
< 60	24	534
≥ 60	18	488
Gender (n)			0.322	χ2
Male	23	637
Female	19	385
BMI, median (IQR)	23.05 (21.70, 25.22)	23.24 (21.22, 25.39)	0.944	Wilcoxon
Diseases (n)			0.003	Yates’ correction
Biliary tract cancer	25	337
Hepatocellular carcinoma	10	328
Benign disease	7	294
Other malignant disease	0	63
Liver cirrhosis (n)			0.098	χ2
Yes	10	371
No	32	651
Major hepatectomy (n)			< 0.001	χ2
Yes	38	556
No	4	466
Caudate lobectomy (n)			0.046	χ2
Yes	16	250
No	26	772
Pancreaticoduodenectomy (n)			< 0.001	Fisher test
Yes	6	5
No	36	1017
Portal vein reconstruction (n)			< 0.001	Yates’ correction
Yes	20	70
No	22	952
Hepatic vein reconstruction (n)			0.046	Fisher test
Yes	2	7
No	40	1015
Bile duct resection (n)			< 0.001	χ2
Yes	28	362
No	14	660
Operation time (minute), median (IQR)	667.5 (532.75, 750.75)	469 (325, 637)	< 0.001	Wilcoxon
Blood loss (mL), median (IQR)	400 (200, 600)	250 (100, 500)	0.005	Wilcoxon
Blood transfusion (n)			0.016	χ2
Yes	28	488
No	14	534
Postoperative portal vein angle			< 0.001	χ2
≥ 100°	16	387
< 100°	22	167
Main portal vein diameter (mm), median (IQR)	11 (10, 12)	11 (9, 12)	0.147	Wilcoxon
Pringle maneuver time (minute), median (IQR)	69.69 (58.28, 119.49)	55 (33.77, 83.90)	0.001	Wilcoxon
Preoperative laboratory test
Platelet count (9 × 104/μL), median (IQR)	175 (130, 255)	195 (146, 260)	0.318	Wilcoxon
PTINR, median (IQR)	1.02 (0.96, 1.08)	1.03 (0.97, 1.09)	0.902	Wilcoxon
FDP (μg/mL), median (IQR)	2.50 (2.50, 3.68)	2.50 (2.50, 2.62)	0.269	Wilcoxon
D-dimer (μg/mL), median (IQR)	0.56 (0.26, 2.00)	0.36 (0.15, 0.86)	0.017	Wilcoxon
Postoperative laboratory test
Platelet count (9 × 104/μL), median (IQR)	113 (83, 168)	158 (111, 212)	< 0.001	Wilcoxon
PTINR, median (IQR)	1.24 (1.17, 1.40)	1.16 (1.08, 1.25)	< 0.001	Wilcoxon
FDP (μg/mL), median (IQR)	28.74 (21.44, 49.00)	22.10 (13.15, 33.17)	0.014	Wilcoxon
D-dimer (μg/mL), median (IQR)	11.04 (7.23, 16.60)	8.13 (5.68, 12.80)	0.004	Wilcoxon

PH-PVT: Post-hepatectomy portal vein thrombosis; PTINR: Prothrombin time-international normalized ratio; FDP: Fibrinogen degradation product; BMI: Body mass index; IQR: Interquartile range.

Table 3 Univariate and multivariate logistic analysis of the risk factors for post-hepatectomy portal vein thrombosis

Characteristics	n	Univariate analysis		Multivariate analysis
		OR (95%CI)	P value	OR (95%CI)	P value
Disease
Benign disease	301	Reference		Reference
Other malignant disease	63	0.000 (0.000-Infinity)	0.986	0.000 (0.000-Infinity)	0.987
Hepatocellular carcinoma	338	1.280 (0.481-3.407)	0.620	1.416 (0.402-4.995)	0.588
Biliary tract cancer	362	3.116 (1.328-7.309)	0.009	1.131 (0.376-3.400)	0.827
Caudate lobectomy
No	798	Reference		Reference
Yes	266	1.900 (1.003-3.600)	0.049	0.585 (0.238-1.437)	0.242
Pancreaticoduodenectomy
No	1053	Reference		Reference
Yes	11	33.900 (9.884-116.268)	< 0.001	7.627 (1.390-41.842)	0.019
Portal vein reconstruction
No	974	Reference		Reference
Yes	90	12.364 (6.439-23.739)	< 0.001	6.119 (2.636-14.203)	< 0.001
Hepatic vein reconstruction
No	1055	Reference		Reference
Yes	9	7.250 (1.459-36.014)	0.015	2.314 (0.312-17.180)	0.412
Bile duct resection
No	674	Reference		Reference
Yes	390	3.646 (1.896-7.014)	< 0.001	1.169 (0.390-3.508)	0.781
Operation time (minute)	1064	1.003 (1.002-1.004)	< 0.001	1.000 (0.997-1.002)	0.772
Blood loss (mL)	1064	1.000 (1.000-1.001)	0.238
Blood transfusion
No	548	Reference		Reference
Yes	516	2.189 (1.139-4.206)	0.019	0.627 (0.253-1.549)	0.311
Pringle maneuver time (minute)	1060	1.011 (1.005-1.016)	< 0.001	1.007 (0.998-1.016)	0.111
Postoperative portal vein angle
≥ 100°	403	Reference		Reference
< 100°	189	3.185 (1.631-6.211)	< 0.001	2.457 (1.131-5.348)	0.023
Preoperative laboratory test
D-dimer (μg/mL)	1064	1.047 (0.951-1.153)	0.347
Postoperative laboratory test
Platelet count (9 × 104/μL)	1064	0.991 (0.986-0.996)	< 0.001	0.996 (0.990-1.002)	0.242
PTINR	1064	1.237 (1.032-1.483)	0.022	2.191 (0.826-5.814)	0.115
D-dimer (μg/mL)	1064	1.027 (0.998-1.057)	0.071
FDP (μg/mL)	1064	1.005 (0.998-1.013)	0.147

PTINR: Prothrombin time-international normalized ratio; FDP: Fibrinogen degradation product; OR: Odds ratio; CI: Confidence interval.

Table 4 Univariate and multivariate logistic analysis of the risk factors for mortality of post-hepatectomy portal vein thrombosis

Characteristics	n	Univariate analysis		Multivariate analysis
		OR (95%CI)	P value	OR (95%CI)	P value
Age
< 60	24	Reference		Reference
≥ 60	18	7.857 (1.877-32.896)	0.005	8.688 (1.774-42.539)	0.008
Disease
Benign disease	7	Reference
Biliary tract cancer	25	6.500 (0.680-62.148)	0.104
Hepatocellular carcinoma	10	0.667 (0.035-12.839)	0.788
Pancreaticoduodenectomy
No	36	Reference
Yes	6	3.47 × 108 (0.000-Infinity)	0.994
Portal vein reconstruction
No	22	Reference		Reference
Yes	20	5.500 (1.361-22.223)	0.017	6.182 (1.246-30.687)	0.026

OR: Odds ratio; CI: Confidence interval.