Kim Josephine S, Mills Kathryn A, Fehniger Julia, Liao Chuanhong, Hurteau Jean A, Kirschner Carolyn V, Lee Nita K, Rodriguez Gustavo C, Yamada S Diane, Diaz Moore Elena S, Tenney Meaghan E
*Section of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Chicago Medicine, Chicago, IL; †Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, NorthShore University HealthSystem, Evanston, IL; and ‡Department of Public Health Sciences, University of Chicago, Chicago, IL.
Int J Gynecol Cancer. 2017 Oct;27(8):1774-1782. doi: 10.1097/IGC.0000000000001084.
This study aims to determine the rate of postoperative venous thromboembolism (VTE) in endometrial cancer patients undergoing robotic hysterectomy with or without extended pharmacologic VTE prophylaxis.
METHODS/MATERIALS: A retrospective chart review of women undergoing robotic hysterectomy with or without other procedures for endometrial cancer from January 2010 to February 2015 was conducted at 2 institutions. Charts were manually abstracted, and rates of VTE within 30 and 60 days after surgery were determined. Patients were then stratified by those who did and did not receive extended VTE prophylaxis.
A total of 403 patients were included, of which 367 patients (91%) received extended pharmacologic prophylaxis and 36 patients (9%) did not. Low molecular weight heparin prescriptions ranged from 7 to 30 days. Patients receiving extended prophylaxis (EP) were older (63 ± 11 vs 57 ± 12; P = 0.004), more frequently underwent lymphadenectomy (67% vs 34%; P < 0.001), and had higher-grade tumors compared with patients not receiving EP. Overall 30-day and 60-day VTE rates were 0.7% and 1.2%, respectively. There were no significant differences in 30-day and 60-day VTE rates among patients that did and did not receive EP, although a trend toward lower VTE rates in the EP group was observed (30-day rates 0.5% vs 2.8% respectively, P = 0.25; 60-day rates 0.8% vs 5.6%, P = 0.07).
In this study, 30-day and 60-day VTE rates after minimally invasive surgery for endometrial cancer were low. Rates were also similar to those of previous reports in this setting in which the majority of patients did not receive extended VTE prophylaxis. Given the consistent finding that postoperative VTE in this population is rare regardless of prophylaxis use and the variability in practice patterns for VTE prophylaxis, the development of best practice guidelines for EP use specific to this setting is warranted.
本研究旨在确定接受机器人子宫切除术的子宫内膜癌患者在使用或不使用延长药物性静脉血栓栓塞（VTE）预防措施的情况下术后VTE的发生率。
方法/材料：在两家机构对2010年1月至2015年2月期间接受机器人子宫切除术（无论是否进行其他子宫内膜癌手术）的女性进行回顾性病历审查。手动提取病历，并确定术后30天和60天内的VTE发生率。然后根据是否接受延长VTE预防措施对患者进行分层。
共纳入403例患者，其中367例（91%）接受了延长药物预防，36例（9%）未接受。低分子量肝素的处方时间为7至30天。接受延长预防（EP）的患者年龄较大（63±11岁对57±12岁；P = 0.004），更频繁地接受淋巴结切除术（67%对34%；P < 0.001），与未接受EP的患者相比，肿瘤分级更高。总体30天和60天VTE发生率分别为0.7%和1.2%。接受和未接受EP的患者在30天和60天VTE发生率上没有显著差异，尽管观察到EP组VTE发生率有降低趋势（30天发生率分别为0.5%对2.8%，P = 0.25；60天发生率分别为0.8%对5.6%，P = 0.07）。
在本研究中，子宫内膜癌微创手术后30天和�0天VTE发生率较低。这些发生率也与之前在大多数患者未接受延长VTE预防措施的情况下的报告相似。鉴于一致的发现，即无论是否使用预防措施，该人群术后VTE都很罕见，且VTE预防的实践模式存在差异，因此有必要制定针对该情况的EP使用最佳实践指南。
