Utility of plasma D-dimer for diagnosis of venous thromboembolism after hepatectomy

Table 1 Clinicopathological characteristics of patients enrolled in this cohort

Variables	Hepatectomy (n = 234)
Age, yr	72 (33-93)
Sex (male/ female) (%)	177/57 (76/24)
Disease (%)
Hepatocellular carcinoma	198 (84)
Intrahepatic cholangiocarcinoma	11 (5)
Perihilar cholangiocarcinoma	25 (11)
Surgical procedures
Major hepatectomy	59 (25)
Minor hepatectomy	175 (75)
Laparotomy	40
Laparoscopic	135
Operation time (min)	410 (92-762)
Blood loss (mL)	150 (0-5330)
VTE	13 (5.6)
DVT	12
PE	2

VTE: Venous thromboembolism; DVT: Deep vein thrombosis; PE: Pulmonary embolism.

Table 2 Comparison of clinicopathological factors with and without venous thromboembolism in the patients with hepatectomy (n = 192)

Variables	VTE (+) (n = 12)	VTE (-) (n = 180)	P value
Age, yr (range) (median)	73 (59-84)	72 (33-91)	0.4635
Sex
Male/female	9 (75)/3 (25)	135 (75)/45 (25)	0.65
BMI (kg/m2) (median)	23.4 (17.7-28.3)	22.7 (13.1-38.9)	0.7864
Disease
HCC	8	148
IHCC	0	11
PHCC	4	21
Major/minor hepatectomy (%)	6 (50)/6(50)	45 (25)/135(75)	0.0576
Laparoscopy (%)	4 (33)	109 (61)	0.0635
Smoking (%)	8 (67)	109 (61)	0.6744
Hypertension (%)	9 (75)	95 (53)	0.1347
Diabetes mellitus (%)	5 (42)	64 (36)	0.6692
Cardiovascular disease (%)	1 (8)	20 (11)	0.7653
Anticoagulation (%)	2 (17)	19 (11)	0.5114
History of VTE	0	0	-
DVT/PE	11/2	0/0
Operation time (min) (median)	529 (250-611)	403 (92-762)	0.0274
Blood loss (mL) (median)	530 (10-2515)	138 (10-5330)	0.0067
Postoperative complication (≥ CDIIIb)	1 (8)	4 (2)	0.1984
Ddimer (μg/mL) (median)
POD1 (range)	10.4 (5-21.7)	6 (1.1-48.5)	0.005
POD3 (range)	16.7 (4.7-54.6)	7.3 (1.1-75)	0.0029
POD5 (range)	29.5 (12.9-65)	13.3 (2.7-167.3)	0.0163
POD7 (range)	26.1 (15.1-75.8)	15.5 (2.2-138.9)	0.0029

HCC: Hepatocellular carcinoma; IHCC: Intrahepatic cholangiocarcinoma; PHCC: Perihilar cholangiocarcinoma; VTE: Venous thromboembolism; DVT: Deep vein thrombosis; PE: Pulmonary embolism; CD: Clavien-Dindo classification; POD: Postoperative day.

Table 3 Detailed list of the patients with venous thromboembolism (n = 12)

No.	Disease	Extent of resection	Date of diagnosis	D-dimer (time of diagnosis)	Method of diagnosis	Diagnosis	Treatment
1	HCC + GC	Partial (S7)	POD 7	20.6	US	DVT	Anticoagulant
2	HCC	Segmental (S5 + 8)	POD 15	32.3	US	DVT	Anticoagulant
3	HCC	Segmental (S6 + 7)	POD 7	55.6	US	DVT	Anticoagulant
4	HCC	Segmental (S4) + partial (S8)	POD 3	30.2	US	DVT	Observation
5	HCC	Right lobectomy + partial (S2)	POD 7	23.1	US	DVT	Observation
6	PHCC	Left hemihepatectomy	POD 7	75.8	CECT	PE	Anticoagulant
7	PHCC	Left hemihepatectomy	POD 6	57.8	CECT	PE/DVT	Anticoagulant
8	HCC	Segmental (S5 + 8)	POD 7	25.5	US	DVT	Observation
9	PHCC	Left hemihepatectomy	POD 21	17.4	US	DVT	Observation
10	PHCC	Left hemihepatectomy	POD 7	15.1	CECT	PE	Anticoagulant
11	HCC	Segmental (S6 + 7)	POD 11	37.3	US	DVT	Anticoagulant
12	HCC	Right hemihepatectomy	POD 7	43.6	US	DVT	Observation

VTE: Venous thromboembolism; HCC: Hepatocellular carcinoma; GC: Gastric cancer; PHCC: Perihilar cholangiocarcinoma; POD: Postoperative day; US: Ultrasonography; CECT: Contrast enhanced computed tomography; DVT: Deep vein thrombosis; PE: Pulmonary embolism.

Table 4 Logistic regression analyses of factors associated with venous thromboembolism among patients undergoing hepatectomy

Variables	Univariate analysis			Multivariate analysis
	OR	95%CI	P value	OR	95%CI	P value
Sex (female)	1.0	0.26-3.86	1.0
Age ≥ 70 yr	1.2	0.35-4.19	0.7585
Major hepatectomy	3	0.10-1.09	0.0682
Minimally invasivehepatectomy	3.07	0.89-10.6	0.0755
BMI ≥ 25 kg/m2	1.17	0.34-4.04	0.8078
HT	2.68	0.70-10.2	0.1484
DM	1.29	0.39-4.25	0.6700
Cardiovascular disease	0.72	0.09-5.93	0.7662
Smoking	1.3	0.38-4.49	0.6751
Anticoagulation	1.7	0.25-8.31	0.5157
Ope time ≥ 462 (min)	5.3	1.39-20.3	0.0147	3.37	0.80-14.2	0.0978
Blood loss ≥ 275 (mL)	10	2.12-47.1	0.0036	5.32	1.05-27.0	0.0435
Blood transfusion	4.48e-7		0.9902
DD (POD 5) ≥ 21 (μg/mL)	14.8	3.11-70.1	< 0.0001	10.1	2.04-50.1	0.0046
Complication (≥ CDIIIb)	4.0	0.41-38.8	0.2322

VTE: Venous thromboembolism; OR: Odds ratio; BMI: Body mass index; HT: Hypertension; DM: Diabetes mellitus; POD: Postoperative day; DD: D-dimer; CD: Clavien-Dindo classification; CI: Confidence interval.