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Portal Venous Thrombosis After Distal Pancreatectomy: Risk Factors and Outcomes
Ashwin S. Kamath*1, Michael L. Kendrick1, Michael G. Sarr1, David M. Nagorney1, Robert Mcbane2, Michael B. Farnell1, Kaye M. Reid Lombardo1, Florencia G. Que1
1General Surgery, Mayo Clinic, Rochester MN, Rochester, MN; 2Cardiovascular Diseases, Mayo Clinic, Rochester MN, Rochester, MN
Aim: Outcomes of patients developing portal vein (PV) thrombosis (PVT) after distal pancreatectomy (DP) are unknown. The goal of this study was to identify risk factors for PVT and describe the long term outcomes in these patients.
Methods: Patients undergoing DP without repair or reconstruction of the PV between 2001 and 2011 were included. Patients that showed evidence of PVT on pre-operative imaging were excluded from the study. Location and extent of thrombosis was determined by postoperative CT or ultrasound imaging in all patients. Evidence of systemic thrombosis (if present) in addition to PVT was also documented.
Results: In the study period, 991 patients underwent DP and 21 (2.1 %) patients were diagnosed with PVT. Pancreatic neoplasm was the most frequent indication for operation (n = 11). Thrombus occurred in the main PV in 15 and the right branch of the PV in 8 patients. Complete PV occlusion occurred in 9 patients with a median time to diagnosis of 16 days (range 5 - 85 days). Seventeen patients were anticoagulated for a median duration of 6 months (range 3.3 - 36 months) after the diagnosis of PVT. Over a median follow up of 22 months, resolution of PVT occurred in 7 patients. Predictors of non-resolution of PVT included anesthesia time >180 minutes (p = 0.025), DM type II (p = 0.03), BMI >30 Kg/m2 (p = 0.03), occlusive PVT (p <0.001), or thrombus in a sectoral branch (p = 0.02). Anticoagulation therapy did not influence the frequency of thrombus resolution and was complicated by gastrointestinal hemorrhage in 4 patients. There was no mortality as a direct result of PVT or anticoagulation.
Conclusion: PVT after distal pancreatectomy is a rare complication. Serious complications as a direct result of PVT in this setting are uncommon and are not dependent on thrombus resolution. Although anticoagulation does not appear to influence the rate of PVT resolution in this small retrospective series, we support the use of anticoagulation until larger, controlled-studies define clear advantages or disadvantages.
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