Styliani Mantziari1, Caroline Gronnier2, Arnaud Pasquer3, Johan Gagnière4, Jérémie Théreaux5, Nicolas Demartines1, Markus Schäfer1, Christophe Mariette6. 1. Department of Visceral Surgery, Lausanne University Hospital, Switzerland. 2. Department of Digestive and Oncological Surgery, Louis Mourier University Hospital, Colombes, France. 3. Department of Digestive Surgery, Edouard Herriot University Hospital, Lyon, France. 4. Department of Digestive Surgery, Estaing University Hospital, Clermont-Ferrand, France. 5. Department of Digestive Surgery, Cavale Blanche University Hospital, Brest, France. 6. Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, Lille, France. Electronic address: christophe.mariette@chru-lille.fr.
Abstract
BACKGROUND: Major oncologic surgery is associated with a high incidence of venous thromboembolic events (VTE), including deep venous thrombosis (DVT) and pulmonary embolism (PE). However, the incidence and risk factors for symptomatic VTE during curative treatment for patients with esophageal cancer are poorly documented. METHODS: Data were collected from 30 European centers from 2000 to 2010. The incidence of in-hospital VTE was assessed in 2,944 patients with esophageal cancer having surgery with curative intent, and 50 clinically relevant parameters were assessed as potential risk factors for VTE. Patients received low molecular weight heparin prophylaxis during hospital stay and for 4 weeks after surgery. RESULTS: Eighty-four patients (2.9%) developed a symptomatic VTE; all of them had a DVT and 44 were also diagnosed with a PE. In the VTE group there were 19 postoperative deaths recorded, 5 of which (26.3%) were directly caused by PE at postoperative days 7, 10, 21, 45, and 48 despite VTE prophylaxis. In-hospital postoperative mortality was significantly higher in VTE patients (23% versus 7%, p < 0.001) and mean hospital stay was also longer in this group (33 ± 24 versus 25 ± 21 days, p < 0.001). Multivariable analysis showed that high American Society of Anesthesiologists (ASA) class (p = 0.008), pneumopathy (p = 0.002), or an acute respiratory distress syndrome (ARDS) (p = 0.015) were significantly associated with VTE. CONCLUSIONS: Patients with ASA class III or IV and those who present a postoperative pneumopathy or ARDS seem to be at higher risk for VTE. Thus, current VTE screening and thromboprophylaxis for these patients might be inadequate and needs further investigation.
BACKGROUND: Major oncologic surgery is associated with a high incidence of venous thromboembolic events (VTE), including deep venous thrombosis (DVT) and pulmonary embolism (PE). However, the incidence and risk factors for symptomatic VTE during curative treatment for patients with esophageal cancer are poorly documented. METHODS: Data were collected from 30 European centers from 2000 to 2010. The incidence of in-hospital VTE was assessed in 2,944 patients with esophageal cancer having surgery with curative intent, and 50 clinically relevant parameters were assessed as potential risk factors for VTE. Patients received low molecular weight heparin prophylaxis during hospital stay and for 4 weeks after surgery. RESULTS: Eighty-four patients (2.9%) developed a symptomatic VTE; all of them had a DVT and 44 were also diagnosed with a PE. In the VTE group there were 19 postoperative deaths recorded, 5 of which (26.3%) were directly caused by PE at postoperative days 7, 10, 21, 45, and 48 despite VTE prophylaxis. In-hospital postoperative mortality was significantly higher in VTEpatients (23% versus 7%, p < 0.001) and mean hospital stay was also longer in this group (33 ± 24 versus 25 ± 21 days, p < 0.001). Multivariable analysis showed that high American Society of Anesthesiologists (ASA) class (p = 0.008), pneumopathy (p = 0.002), or an acute respiratory distress syndrome (ARDS) (p = 0.015) were significantly associated with VTE. CONCLUSIONS:Patients with ASA class III or IV and those who present a postoperative pneumopathy or ARDS seem to be at higher risk for VTE. Thus, current VTE screening and thromboprophylaxis for these patients might be inadequate and needs further investigation.
Authors: Donald E Low; William Allum; Giovanni De Manzoni; Lorenzo Ferri; Arul Immanuel; MadhanKumar Kuppusamy; Simon Law; Mats Lindblad; Nick Maynard; Joseph Neal; C S Pramesh; Mike Scott; B Mark Smithers; Valérie Addor; Olle Ljungqvist Journal: World J Surg Date: 2019-02 Impact factor: 3.352
Authors: Michelle B Mulder; Kenneth G Proctor; Evan J Valle; Alan S Livingstone; Dao M Nguyen; Robert M Van Haren Journal: World J Surg Date: 2019-12 Impact factor: 3.352