Department of Gastrointestinal Surgery, National Institute for Health Research Nottingham Digestive Diseases Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom.
Dis Colon Rectum. 2021 Apr 1;64(4):484-496. doi: 10.1097/DCR.0000000000001946.
Colorectal cancer has the second highest mortality of any malignancy, and venous thromboembolism is a major postoperative complication.
This study aimed to determine the variation in incidence of venous thromboembolism after colorectal cancer resection.
Following PRISMA and MOOSE guidelines (PROSPERO, ID: CRD42019148828), Medline and Embase databases were searched from database inception to August 2019 including 3 other registered medical databases.
Two blinded reviewers screened studies with a third reviewer adjudicating any discordance. Eligibility criteria: Patients post colorectal cancer resection aged ≥18 years. Exclusion criteria: Patients undergoing completely endoscopic surgery and those without cancer resection. Selected studies were randomized controlled trials and population-based database/registry cohorts.
Thirty- and 90-day incidence rates of venous thromboembolism per 1000 person-years following colorectal cancer surgery.
Of 6441 studies retrieved, 28 met inclusion criteria. Eighteen were available for meta-analysis reporting on 539,390 patients. Pooled 30- and 90-day incidence rates of venous thromboembolism following resection were 195 (95% CI, 148-256, I2 99.1%) and 91 (95% CI, 56-146, I2 99.2%) per 1000 person-years. When separated by United Nations Geoscheme Areas, differences in the incidence of postoperative venous thromboembolism were observed with 30- and 90-day pooled rates per 1000 person-years of 284 (95% CI, 238-339) and 121 (95% CI, 82-179) in the Americas and 71 (95% CI, 60-84) and 57 (95% CI, 47-69) in Europe.
A high degree of heterogeneity was observed within meta-analyses attributable to large cohorts minimizing within-study variance.
The incidence of venous thromboembolism following colorectal cancer resection is high and remains so more than 1 month after surgery. There is clear disparity between the incidence of venous thromboembolism after colorectal cancer surgery by global region. More robust population studies are required to further investigate these geographical differences to determine valid regional incidence rates of venous thromboembolism following colorectal cancer resection.
结直肠癌的死亡率在所有恶性肿瘤中排名第二，静脉血栓栓塞是术后的主要并发症。
本研究旨在确定结直肠癌切除术后静脉血栓栓塞的发生率差异。
根据 PRISMA 和 MOOSE 指南（PROSPERO，ID：CRD42019148828），从数据库建立到 2019 年 8 月，对 Medline 和 Embase 数据库进行了检索，包括另外 3 个已注册的医学数据库。
两名盲审员筛选研究，第三名评审员对任何不一致进行裁决。纳入标准：年龄≥18 岁的结直肠癌术后患者。排除标准：完全内镜手术患者和无癌症切除患者。入选研究为随机对照试验和基于人群的数据库/登记队列。
结直肠癌手术后 30 天和 90 天的静脉血栓栓塞发生率，每 1000 人年。
在 6441 项研究中，有 28 项符合纳入标准。18 项研究进行了荟萃分析，报告了 539390 例患者。切除术后 30 天和 90 天静脉血栓栓塞的合并发生率分别为 195（95%CI，148-256，I2 99.1%）和 91（95%CI，56-146，I2 99.2%）/1000 人年。按联合国地理方案区域划分，观察到术后静脉血栓栓塞发生率存在差异，美洲的 30 天和 90 天合并发生率分别为每 1000 人年 284（95%CI，238-339）和 121（95%CI，82-179），欧洲为 71（95%CI，60-84）和 57（95%CI，47-69）。
荟萃分析中存在高度异质性，这归因于最大限度地减少了研究内方差的大型队列。
结直肠癌切除术后静脉血栓栓塞的发生率较高，手术后 1 个月以上仍如此。全球范围内结直肠癌手术后静脉血栓栓塞的发生率存在明显差异。需要进行更有力的人群研究，以进一步调查这些地域差异，确定结直肠癌切除术后静脉血栓栓塞的有效区域发生率。
