Department of General Surgery, Long Island Jewish Hospital, Northwell Health, 270-05 76th Ave, Queens, NY, 11040, USA.
Division of Surgical Oncology, Northwell Health, 450 Lakeville Rd, Lake Success, NY, 11042, USA.
J Thromb Thrombolysis. 2019 Feb;47(2):316-323. doi: 10.1007/s11239-018-1774-3.
Malignancy and surgery are both independent risk factors for venous thromboembolism (VTE) events. The current NCCN guidelines recommend VTE prophylaxis for up to 28 days after major abdominal or pelvic surgery for malignancy. We set out to evaluate the rate and timing of VTEs among patients with gastric, pancreatic, colorectal, and gynecologic malignancies who underwent surgery. We performed a retrospective review of the NSQIP database (2005-2013) focusing on patients with gastric, colorectal, pancreatic, and gynecologic malignancies. Our primary endpoint was a diagnosis of VTE within 30 days of surgery. We analyzed 128,864 patients in this study. On multivariable analysis, patients with pre-operative sepsis (OR 2.36, CI 2.04-2.76, p < 0.001), disseminated cancer (OR 1.73, CI 1.55-1.92, p < 0.001), congestive heart failure (OR 1.69, CI 1.25-2.28, p = 0.001), gastric cancer (OR 1.3, CI 1.09-1.56, p = 0.004), and pancreatic cancer (OR 1.2, CI 1.03-1.30, p = 0.021) were more likely to have a VTE. Of patients who had a VTE event, 34% occurred after discharge from surgery (gastric: 25%, colorectal 34%, pancreatic 31%, gynecologic malignancy 42%). Our study demonstrates that patients who undergo an operation for malignancy with pre-operative sepsis, disseminated cancer, congestive heart failure, gastric cancer, or pancreatic cancer are more likely to develop a VTE within 30 days of their operation. Of those patients who developed a VTE, approximately one-third occurred after discharge during a 30 day post-operative period. This data supports that further studies are needed to determine the appropriate length of post-operative VTE chemoprophylaxis in patients with cancer.
恶性肿瘤和手术都是静脉血栓栓塞症 (VTE) 事件的独立危险因素。目前的 NCCN 指南建议对接受恶性肿瘤大腹部或盆腔手术的患者进行长达 28 天的 VTE 预防。我们旨在评估接受胃癌、胰腺癌、结直肠癌和妇科恶性肿瘤手术的患者中 VTE 的发生率和时间。我们对 NSQIP 数据库（2005-2013 年）进行了回顾性研究，重点关注胃癌、结直肠癌、胰腺癌和妇科恶性肿瘤患者。我们的主要终点是术后 30 天内诊断出 VTE。本研究共分析了 128864 例患者。多变量分析显示，术前脓毒症（OR 2.36，95%CI 2.04-2.76，p<0.001）、播散性癌症（OR 1.73，95%CI 1.55-1.92，p<0.001）、充血性心力衰竭（OR 1.69，95%CI 1.25-2.28，p=0.001）、胃癌（OR 1.3，95%CI 1.09-1.56，p=0.004）和胰腺癌（OR 1.2，95%CI 1.03-1.30，p=0.021）患者发生 VTE 的可能性更高。发生 VTE 的患者中，34%发生在手术后出院后（胃癌：25%，结直肠癌：34%，胰腺癌：31%，妇科恶性肿瘤：42%）。我们的研究表明，接受手术治疗恶性肿瘤且术前存在脓毒症、播散性癌症、充血性心力衰竭、胃癌或胰腺癌的患者，在手术后 30 天内发生 VTE 的可能性更高。在发生 VTE 的患者中，约有三分之一发生在术后 30 天的出院期间。这一数据支持需要进一步研究，以确定癌症患者术后 VTE 化学预防的适当时间长度。
