Postoperative Portomesenteric Venous Thrombosis After Colorectal Cancer Surgery

Portomesenteric venous thrombosis (PMVT) can occur after colorectal surgery. Most previous studies included patients with various diseases, especially inflammatory bowel disease. The prevalence and clinical significance of PMVT developing after surgery for colorectal cancer (CRC) remain unclear.

Consecutive patients who underwent resection for CRC between June 2003 and April 2016 were retrospectively analyzed. Postoperative PMVT was diagnosed based on pre- and postoperative computed tomography (CT).

Postoperative PMVT developed in 10 (0.24%) of 4232 patients who underwent resection for CRC. One patient had alcoholic liver cirrhosis, whereas nine did not have prior or current liver disease. PMVT in eight patients was detected within 2 weeks after surgery by CT, performed to evaluate non-specific symptoms such as mild fever and abdominal pain, or performed postoperatively after deep pelvic dissection. PMVT in the remaining two asymptomatic patients was diagnosed following surveillance CT 3 and 7 months after surgery, respectively. PMVT in the patient with liver cirrhosis was detected 13 days after surgery and found to involve the main portal vein, causing hyperbilirubinemia and requiring emergency thrombectomy with thrombolysis. PMVT in the nine patients without liver disease was resolved by anticoagulation therapy or conservative care without long-term complications.

PMVT after CRC surgery is likely an early postoperative event in most patients. The incidence of clinically significant PMVT in patients with CRC may be lower than previously reported. CT was reliable in the diagnosis and follow-up of these patients. Most patients with PMVT can be managed conservatively without serious long-term morbidity.