Department of Surgery, Toyonaka Municipal Hospital, 4-14-1 Shibahara, Toyonaka, Osaka, 560-8565, Japan.
Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, Sapporo, Japan.
Surg Endosc. 2022 Sep;36(9):6432-6438. doi: 10.1007/s00464-021-08991-0. Epub 2022 Feb 4.
The number of patients taking antiplatelet therapy is increasing. However, there is no definitive guideline for the perioperative management of antiplatelet therapy. Conventionally, the discontinuation of antiplatelet drugs has been the basic treatment as perioperative management. Therefore, we investigated the risk of discontinuing aspirin concerning thrombotic complications in laparoscopic colorectal cancer surgery.
Between January 2015 and December 2019, a total of 729 patients underwent laparoscopic colorectal cancer surgery in Toyonaka Municipal Hospital. Sixty-four patients taking antithrombotic drugs aside from aspirin were excluded from this study; the remaining 665 patients were considered eligible and divided into three groups. The patients not taking aspirin were classified as the "Control group" (n = 588). Among the patients taking aspirin, those who continued preoperative aspirin were classified as the "Aspirin group" (n = 30), and those who discontinued preoperative aspirin were classified as the "No-aspirin group" (n = 47). The Aspirin, No-aspirin, and Control groups were compared retrospectively.
Among the 3 groups, there were no significant difference in operative time (p = 0.14), bleeding volume (p = 0.63), or postoperative hospital stay (p = 0.06). Assessing the postoperative complication, bleeding complications were significantly more frequent in the Aspirin group (p < 0.01), although those complications were all Clavien-Dindo grade II. In contrast, thrombotic complications were significantly more frequent in the No-aspirin group (p < 0.01). Note that those complications were all Clavien-Dindo Grade III/IV. This result suggested that discontinuing aspirin increased the risk of severe thrombotic complication.
Discontinuation of aspirin as perioperative management in laparoscopic colorectal cancer surgery increased the risk of severe thrombotic complications.
服用抗血小板药物的患者数量正在增加。然而，目前尚无针对抗血小板治疗围手术期管理的明确指南。传统上，停止使用抗血小板药物一直是围手术期管理的基本治疗方法。因此，我们研究了停止使用阿司匹林对腹腔镜结直肠癌手术中血栓并发症的风险。
在 2015 年 1 月至 2019 年 12 月期间，共有 729 名患者在丰中市医院接受了腹腔镜结直肠癌手术。本研究排除了除阿司匹林外还服用抗血栓药物的 64 名患者；其余 665 名患者被认为符合条件并分为三组。未服用阿司匹林的患者被归类为“对照组”（n=588）。在服用阿司匹林的患者中，继续术前服用阿司匹林的患者被归类为“阿司匹林组”（n=30），而停止术前服用阿司匹林的患者被归类为“无阿司匹林组”（n=47）。回顾性比较了阿司匹林组、无阿司匹林组和对照组。
三组之间手术时间（p=0.14）、出血量（p=0.63）或术后住院时间（p=0.06）无显著差异。评估术后并发症时，阿司匹林组出血并发症明显更为频繁（p<0.01），尽管这些并发症均为 Clavien-Dindo 分级 II 级。相反，无阿司匹林组血栓并发症明显更为频繁（p<0.01）。值得注意的是，这些并发症均为 Clavien-Dindo 分级 III/IV 级。这一结果表明，停止阿司匹林治疗会增加严重血栓并发症的风险。
腹腔镜结直肠癌手术中停止使用阿司匹林作为围手术期管理会增加严重血栓并发症的风险。
