Routine contrast-enhanced CT screening identifies asymptomatic pulmonary embolism after minimally invasive esophagectomy: incidence and associated factors

BACKGROUND: Esophagectomy is associated with a higher incidence of venous thromboembolism, including pulmonary embolism (PE), than other gastrointestinal cancer surgeries. However, the true incidence of asymptomatic PE remains unclear. This study aimed to determine the incidence and associated factors of PE using routine contrast-enhanced computed tomography (CECT) after minimally invasive esophagectomy (MIE). METHODS: A total of 134 consecutive patients who underwent MIE between May 2022 and December 2023 under a standardized postoperative CECT protocol were retrospectively analyzed. Routine CECT was performed on or after postoperative day (POD) 5 in all patients. Prophylactic anticoagulation was initiated based on bleeding risk. Study endpoints included PE incidence, identification of factors associated with PE, and the discriminative performance of postoperative coagulation and fibrinolysis biomarkers. RESULTS: PE developed in 13 patients (9.7%), and all cases were asymptomatic. Multivariable analysis identified BMI ≥ 22 kg/m² as independently associated with PE (adjusted OR, 4.53; 95% CI, 1.27-21.4; P = 0.019). Sensitivity analyses showed consistent associations across adjusted models. Among postoperative biomarkers, D-dimer on POD 5 showed the highest discriminative performance for PE, whereas soluble fibrin monomer complex (SFMC) on POD 1 showed moderate discrimination. CONCLUSION: Despite prophylactic anticoagulation, asymptomatic PE occurred in 9.7% of patients after MIE. BMI ≥ 22 kg/m² was independently associated with PE. Postoperative coagulation and fibrinolysis biomarkers, including POD 5 D-dimer and POD 1 SFMC, demonstrated discriminative performance and may provide complementary information in postoperative evaluation of PE.