Bissette Randall, Sandberg Maxwell, Tranchina Stephen, Waggener Kimberly, Snipes Madeline, Ye Emily, Simmons Jabrina, Strobel John, Hemal Ashok, Rodriguez Alejandro, Davis Iii Ronald
Virginia Tech Carilion School of Medicine, Roanoke, Virginia, 24016 United States.
Department of Urology, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, 27157 United States.
Bladder (San Franc). 2024 Dec 6;11(4):e21200020. doi: 10.14440/bladder.2024.0041. eCollection 2024.
Radical cystectomy (RC) for bladder cancer is associated with substantial postoperative complications. Among these complications, venous thromboembolism (VTE), including deep vein thrombosis and pulmonary embolism, is particularly notable for its morbidity. Efforts to reduce VTE have been largely revolving around extended thromboprophylaxis (ETP) after discharge, typically with injectable heparins, and, more recently, with oral anticoagulants.
The purpose of this study was to quantify the incidence of VTE within 90 days following RC and to identify risk factors associated with its development.
We conducted a retrospective review of all patients who underwent RC for bladder cancer at our institution between 2012 and 2024, documenting instances of postoperative VTE. Data on demographics, anticoagulation therapy, surgical approach, and hospitalization were collected and analyzed.
A total of 372 patients received RC for bladder cancer during the study. Of them, 12 patients (3.2%) developed VTE at some point after surgery. The median time to VTE occurrence was between 31 and 90 days post-discharge. A higher rate of VTE was observed immediately following RC in patients who underwent surgery before 2018 ( = 0.021), the year in which enhanced recovery after surgery (ERAS) protocols were implemented. Demographic factors and operation-related variables did not influence the VTE rate ( > 0.05). Kaplan-Meier analysis revealed that cancer-specific survival was significantly lower in patients who developed VTE after RC compared to those who did not ( < 0.001).
These findings underscored the importance of interventions such as ETP and ERAS protocols in reducing the incidence of VTE following RC for bladder cancer.
膀胱癌根治性膀胱切除术（RC）术后会出现大量并发症。在这些并发症中，静脉血栓栓塞症（VTE），包括深静脉血栓形成和肺栓塞，因其发病率而尤为显著。减少VTE的努力主要围绕出院后的延长血栓预防（ETP），通常使用注射用肝素，最近则使用口服抗凝剂。
本研究的目的是量化RC术后90天内VTE的发生率，并确定与其发生相关的危险因素。
我们对2012年至2024年在本机构接受膀胱癌RC手术的所有患者进行了回顾性研究，记录术后VTE的发生情况。收集并分析了人口统计学、抗凝治疗、手术方式和住院情况的数据。
在研究期间，共有372例患者接受了膀胱癌RC手术。其中，12例患者（3.2%）在术后某个时间点发生了VTE。VTE发生的中位时间在出院后31至90天之间。在2018年（即实施术后加速康复（ERAS）方案的年份）之前接受手术的患者中，RC术后立即观察到较高的VTE发生率（ = 0.021）。人口统计学因素和手术相关变量对VTE发生率没有影响（ > 0.05）。Kaplan-Meier分析显示，RC术后发生VTE的患者的癌症特异性生存率显著低于未发生VTE的患者（ < 0.001）。
这些发现强调了ETP和ERAS方案等干预措施在降低膀胱癌RC术后VTE发生率方面的重要性。
