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Emmanuelle Duceppe3, Jean-François Lauzon3, Steven Gallinger1, Betty Zhang2, Hannah Solomon1, Pablo Serrano Aybar*2
1University of Toronto, Toronto, ON, Canada; 2Surgery, McMaster University, Hamilton, ON, Canada; 3Medicine, University of Montreal, Montreal, QC, Canada

INTRODUCTION: Splanchnic vein thrombosis (SVT) refers to thrombosis occurring in the portal system. It can lead to complications such as bowel infarction and chronic portal hypertension. Hepatopancreatobiliary (HPB) surgery can be a precipitating factor for SVT and anticoagulation therapy can be challenging in the postoperative period due to bleeding risk.

METHODS: We performed a retrospective cohort study in adults who underwent HPB surgery in three Canadian tertiary care hospitals to determine the incidence, management and prognosis of SVT occurring within 90 days postoperatively. Multivariable analyses for predictors of SVT and all cause mortality were performed.

RESULTS: We enrolled 1815 consecutive patients who underwent HBP surgery; of which 59 (3.3%) experienced an SVT within 90 days of surgery. Mean age was 63 years, 735 (40.5%) were male and 70 (3.9%) had preoperative cirrhosis. The majority (84.7%) of patients underwent surgery for active cancer and the most common surgical indications were periampullary carcinoma (39.2%) and colorectal cancer liver metastasis (23.6%). The most frequent surgeries were pancreaticoduodenectomy (40.6%), open (30.8%) and laparoscopic (11.0%) liver resection. In patients who suffered SVT, 23.7% were symptomatic and 67.8% were treated with therapeutic anticoagulation. The planned duration of anticoagulation therapy was highly variable. In multivariable analysis, predictors of SVT were duration of surgery (adjusted odds ratio [aOR] 1.33, 95% CI 1.20-1.48), past history of cirrhosis (aOR 3.07, 95% CI 1.11-8.47), and postoperative intraabdominal infection (aOR 2.71, 95% CI 1.49-4.91). Major bleeding occurred in 22.1% of patients, 3.1% suffered a deep vein thrombosis, and 74 patients (4.1%) died within 90 days. The most common causes of mortality were sepsis (18/74; 24.3%) and liver failure (11/74; 14.9%). Independent predictors of postoperative 90-day all-cause mortality were age (aOR per 10-year increase 1.70, 95% CI 1.32-2.19), duration of surgery (aOR per hour increase 1.21 (1.08-1.35), past history of cirrhosis (aOR 3.10, 95% CI 1.31-7.33), postoperative intraabdominal infection (aOR 2.58, 95% CI 1.48-4.50), postoperative major bleeding (aOR 4.03, 95% CI 2.26-7.20), and postoperative SVT (aOR 3.36, 95% CI 1.49-7.61).

CONCLUSION: In patients undergoing HPB surgery, SVT was an uncommon complication but associated with 3-fold independent increase in postoperative 90-day mortality. Further evidence is needed to inform on the management of SVT following HPB surgery.

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