Postoperative Venous Thromboembolism after Minimally Invasive Esophagectomy Detected by Routine Contrast-Enhanced CT: A Single-Center Cohort Study

Background Venous thromboembolism (VTE) is a serious postoperative complication of esophagectomy, and studies limited to symptomatic events may underestimate its true incidence. This study aimed to determine the incidence and risk factors of postoperative VTE using routine contrast-enhanced computed tomography (CT) following minimally invasive esophagectomy (MIE). Methods We retrospectively analyzed 260 patients who underwent curative MIE at Kyoto University Hospital between November 2015 and December 2024. Contrast-enhanced CT was routinely performed around postoperative day 7. VTE incidence, associated clinical factors, and postoperative outcomes were analyzed. Results Routine early postoperative contrast-enhanced CT screening detected asymptomatic VTE in 30 of 257 patients (11.7%), while 3 of 260 patients (1.2%) developed symptomatic pulmonary embolism (PE) diagnosed by urgent contrast-enhanced CT. Overall, postoperative VTE was detected in 33 patients (12.7%), and PE was observed in 15 patients (5.8%). Azygos vein, internal jugular vein, brachiocephalic vein, and femoral vein thrombosis were identified in 9 (3.5%), 7 (2.7%), 1 (0.4%), and 1 (0.4%), respectively. When excluding isolated azygos stump thrombosis to focusing on the VTE in central venous system, univariate and multivariate analyses revealed that advanced age, higher American Society of Anesthesiologists physical status, and McKeown-retrosternal reconstruction were independent predictors of non-azygos VTE. There was no 30-day mortality in the entire cohort. Conclusion Routine early postoperative contrast-enhanced CT identified frequent, largely asymptomatic VTE after minimally invasive esophagectomy. These findings highlight the need for heightened awareness and treatment strategies, although further validation in larger, multi-institutional cohorts is required.