Surgery · Oncology · 1 h ago
Incidental Portomesenteric Thrombosis After Colorectal Cancer Surgery Often Resolves
In a retrospective cohort of 799 patients who underwent colorectal cancer surgery, routine postoperative CT detected asymptomatic portomesenteric venous thrombosis in 4.1%. All cases resolved within one year, including all 12 managed with surveillance alone; no thrombus extension or related complications were reported.
- PMVT was detected in 4.1% of 799 patients.
- All 33 cases resolved within one year.
- All 12 patients managed with surveillance had resolution.
- No extension or related complications were reported.
Portomesenteric venous thrombosis (PMVT) may be found incidentally after colorectal cancer surgery, but its course in asymptomatic patients is not well characterized. In this retrospective study, researchers reviewed 799 consecutive patients operated on between April 2019 and June 2025. All had abdominal CT on postoperative day 6 under the institution’s routine follow-up pathway. The analysis assessed PMVT incidence, location, associated factors, management and radiologic resolution.
Asymptomatic PMVT was identified in 33 patients (4.1%); none had symptoms when detected, and thrombi were mainly confined to distal intrahepatic branches. Twenty-one patients received therapeutic anticoagulation and 12 underwent surveillance without anticoagulation. All 33 had complete radiologic resolution within one year. There were no reported cases of thrombus extension, portal hypertension or bowel ischemia. Age 60 years or younger and a postoperative day 5 white blood cell count above 10 × 10⁹/L were associated with PMVT in an exploratory multivariable analysis.
The authors suggest that these findings support individualized, predominantly conservative management of incidental, short-segment, non-occlusive PMVT confined to peripheral intrahepatic branches, rather than reflexive anticoagulation or extensive workup. The study was retrospective, had only 33 cases and used routine CT at a single institution; it does not establish that surveillance is appropriate for other thrombus locations or clinical presentations. The authors do not advocate routine postoperative CT.
In practice
For patients with incidentally detected, asymptomatic PMVT after colorectal cancer surgery, this single-center retrospective cohort offers reassuring evidence about short-segment thrombi mainly confined to distal intrahepatic branches: all 33 cases resolved within one year, including all 12 patients managed with surveillance alone, with no reported extension or complications. These findings do not establish that anticoagulation can be withheld in other settings. The study included few events and used routine postoperative CT, so its results support individualized assessment rather than a general management rule.
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World Journal of Surgery: Asymptomatic Portomesenteric Venous Thrombosis After Colorectal Cancer Surgery: Incidence, Natural History, and Implications for Management ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.