Early portal vein thrombosis after hepatectomy for perihilar cholangiocarcinoma: Incidence, risk factors, and management.

• Major hepatectomy with associated biliary or even vascular reconstruction is the standard surgical treatment for perihilar cholangiocarcinoma. • The incidence of post-hepatectomy portal thrombosis varies between 2 and 14% depending on the center. • Rapid management adapted to the severity of portal thrombosis probably reduces the morbidity and mortality of this complication. • Particular attention should be paid to the portal anatomy (angulation, stenosis) after radical right hepatectomy, whether or not there is venous reconstruction. Portal reconstruction should only be motivated by a suspicion of invasion. • In the rare cases where the choice is possible, an enlarged left hepatectomy in the anterior sector can be preferred. To study the incidence, risk factors and management of portal vein thrombosis (PVT) after hepatectomy for perihilar cholangiocarcinoma (PHCC). Single-center retrospective analysis of 86 consecutive patients who underwent major hepatectomy for PHCC, between 2012 and 2019, with comparison of the characteristics of the groups with (PVT+) and without (PVT−) postoperative portal vein thrombosis. Seven patients (8%) presented with PVT diagnosed during the first postoperative week. Preoperative portal embolization had been performed in 71% of patients in the PVT+ group versus 34% in the PVT− group (P = 0.1). Portal reconstruction was performed in 100% and 38% of PVT+ and PVT− patients, respectively (P = 0.002). In view of the gravity of the clinical and/or biochemical picture, five (71%) patients underwent urgent re-operation with portal thrombectomy, one of whom died early (hemorrhagic shock after surgical treatment of PVT). Two patients had exclusively medical treatment. Complete recanalization of the portal vein was achieved in the short and medium term in the six survivors. After a mean follow-up of 21 months, there was no statistically significant difference in overall survival between the two groups. Post-hepatectomy PVT for PHCC is a not-infrequent and potentially lethal event. Rapid management, adapted to the extension of the thrombus and the severity of the thrombosis (hepatic function, signs of portal hypertension) makes it possible to limit the impact on postoperative mortality. We did not identify any modifiable risk factor. However, when it is oncologically and anatomically feasible, left ± extended hepatectomy (without portal embolization) may be less risky than extended right hepatectomy, and portal vein resection should only be performed if there is strong suspicion of tumor invasion. [ABSTRACT FROM AUTHOR]