Early Portomesenteric Thrombosis Following Pancreaticoduodenectomy: Risk Factors, Management and Outcomes

ABSTRACT Introduction Early portomesenteric thrombosis (ePMT) can occur following pancreaticoduodenectomy (PD) and is associated with significant postoperative morbidity and mortality. The aim of this study was to identify risk factors associated with early ePMT following PD. Methods We retrospectively analyzed data from a prospective database including all consecutive patients who underwent PD for benign or malignant tumors at our tertiary center between January 2007 and December 2019. Univariable and multivariable analysis were conducted, between the independent groups using penalized maximum likelihood logistic regression. Results 374 patients were included. Nine patients developed early ePMT. Postoperative ePMT occurred at a median of 3.5 days [0‐40] after surgery. Ninety‐day postoperative mortality was significantly higher in the ePMT+ group (OR = 7.1; p < 0.01). Intraoperative blood loss and body mass index (BMI) were independently associated with ePMT following PD (OR = 6.61; IC95 = [1.68;26] and OR = 4.44; IC95 = [1.09;17], respectively). Venous resection during PD and occurrence of POPF were both associated with an increased risk of ePMT, but theses associations were not statistically significant. Conclusion ePMT following PD is rare but represents a severe postoperative complication associated with high mortality rate. It occurs more often in patients with increased intraoperative blood loss and higher BMI, reflecting greater intraoperative technical difficulty during surgery.