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

BACKGROUND Venous thromboembolism(VTE)is a potentially fatal complication of hepatectomy.The use of postoperative prophylactic anticoagulation in patients who have undergone hepatectomy is controversial because of the risk of postoperative bleeding.Therefore,we hypothesized that monitoring plasma D-dimer could be useful in the early diagnosis of VTE after hepatectomy.AIM To evaluate the utility of monitoring plasma D-dimer levels in the early diagnosis of VTE after hepatectomy.METHODS The medical records of patients who underwent hepatectomy at our institution between January 2017 and December 2020 were retrospectively analyzed.Patients were divided into two groups according to whether or not they developed VTE after hepatectomy,as diagnosed by contrast-enhanced computed tomography and/or ultrasonography of the lower extremities.Clinicopathological factors,including demographic data and perioperative D-dimer values,were compared between the two groups.Receiver operating characteristic curve analysis was performed to determine the D-dimer cutoff value.Univariate and multivariate analyses were performed using logistic regression analysis to identify significant predictors.RESULTS In total,234 patients who underwent hepatectomy were,of whom(5.6%)were diagnosed with VTE following hepatectomy.A comparison between the two groups showed significant differences in operative time(529 vs 403 min,P=0.0274)and blood loss(530 vs 138 mL,P=0.0067).The D-dimer levels on postoperative days(POD)1,3,5,7 were significantly higher in the VTE group than in the non-VTE group.In the multivariate analysis,intraoperative blood loss of>275 mL[odds ratio(OR)=5.32,95%confidence interval(CI):1.05-27.0,P=0.044]and plasma D-dimer levels on POD 5≥21μg/mL(OR=10.1,95%CI:2.04-50.1,P=0.0046)were independent risk factors for VTE after hepatectomy.CONCLUSION Monitoring of plasma D-dimer levels after hepatectomy is useful for early diagnosis of VTE and may avoid routine prophylactic anticoagulation in the postoperative period.

Benefits and limitations of middle bile duct segmental resection for extrahepatic cholangiocarcinoma

Background:Pancreaticoduodenectomy(PD)is a standardized strategy for patients with middle and distal bile duct cancers.The aim of this study was to compare clinicopathological features of bile duct segmen-tal resection(BDR)with PD in patients with extrahepatic cholangiocarcinoma.Methods:Consecutive cases with extrahepatic cholangiocarcinoma who underwent BDR(n=21)or PD(n=84)with achievement of R0 or R1 resection in Kobe University Hospital between January 2000 and December 2016 were enrolled in the present study.Results:Patients who underwent PD were significantly younger than those receiving BDR.The frequency of preoperative jaundice,biliary drainage and cholangitis was not significantly different between the two groups.The duration of surgery was longer and there was more intraoperative bleeding in the PD than in the BDR group(553 vs.421 min,and 770 vs.402 mL;both P<0.01).More major complications(>Clavien-DindoⅢa)were observed in the PD group(46%vs.10%,P<0.01).Postoperative hospital stay was also longer in that group(30 vs.19 days,P=0.02).Pathological assessment revealed that tumors were less advanced in the BDR group but the rate of lymph node metastasis was similar in both groups(33%in BDR and 48%in PD,P=0.24).The rate of R0 resection was significantly higher in the PD group(80%vs.38%,P<0.01).Adjuvant chemotherapy was more frequently administered to patients in the BDR group(62%vs.38%,P=0.04).Although 5-year overall survival rates were similar in both groups(44%for BDR and 51%for PD,P=0.72),in patients with T1 and T2,the BDR group tended to have poorer prognosis(44%vs.68%at 5-year,P=0.09).Conclusions:BDR was comparable in prognosis to PD in middle bile duct cancer.Less invasiveness and lower morbidity of BDR justified this technique for selected patients in a poor general condition.