Peri-operative thrombophilia in patients undergoing liver resection for colorectal metastases

Background: Routine chemical venous thromboembolism (VTE) prophylaxis for liver surgery remains controversial, and often delayed post-operatively due to perceived bleeding risk. This study asked whether patients undergoing hepatectomy for colorectal metastases (CRM) were at risk from VTE pre-operatively, and the impact of hepatectomy on that risk.Methods: Single-centre prospective observational cohort study of patients undergoing open hepa-tectomy for CRM, comparing pre-, peri-and post-operative haemostatic variables.Results: Of 336 hepatectomies performed October 2017-December 2019, 60 resections in 57 patients were recruited. There were 28 (46.7%) major resections, with median (interquartile range [IQR]) blood loss 150.0 (76.3-263.7) mls, no blood transfusions, post-operative VTE events or deaths. Patients were prothrombotic pre-operatively (high median factor VIIIC and increased thrombin generation velocity index), an effect exacerbated post-hepatectomy. Major hepatectomies had a significantly greater median drop in Protein C, rise in Factor VIIIC and von Willebrand Factor, versus minor resections (p = 0.001, 0.005, 0.001 respectively). Patients with parenchymal transection times greater than median (40 min), had significantly increased median (IQR) PMBC-TFmRNA expression [1.65(0.93-2.70)2ddCt], versus quicker transections [0.99(0.69-1.28)2ddCt, p = 0.020].Conclusions: Patients with CRM are prothrombotic pre-operatively, an effect exacerbated by hepa-tectomy, particularly longer, complex resections, suggesting chemical thromboprophylaxis be consid-ered early in the patient pathway.

Automated summary

This study observed patients undergoing hepatectomy for colorectal metastases and found that there is a risk of thrombosis before the surgery, which is further increased by the hepatectomy. Based on the results, it is suggested that chemical thromboprophylaxis should be considered early in the patient pathway.