Thereaux Jérémie, Badic Bogdan, Fuchs Basil, Leven Cyril, Caillard Anais, Lacut Karin, Metges Jean-Philippe, Couturaud Francis
University Brest, CHU Brest, Brest, France; Department of General, Digestive and Metabolic Surgery, La Cavale Blanche University Hospital, Boulevard Tanguy Prigent, Brest, France.
Department of General, Digestive and Metabolic Surgery, La Cavale Blanche University Hospital, Boulevard Tanguy Prigent, Brest, France; Univ Brest, CHU Brest, UMR 1304, Western Brittany Thrombosis Group, Brest, France.
Surgery. 2025 May;181:109171. doi: 10.1016/j.surg.2025.109171. Epub 2025 Feb 13.
Venous thromboembolism is a well-recognized complication after hepatopancreatobiliary surgery. However, there is a paucity of nationwide data on risk factors and incidence within 1 year of surgery in patients undergoing hepatopancreatobiliary surgery.
This nationwide observational population-based cohort study used data extracted from all patients undergoing surgery for cancer surgery of the liver and the pancreas in France between 1 January 2015 and 31 December 2017. Estimation of 1 postoperative year cumulative incidence of venous thromboembolism and Cox proportional hazards model on 1-year global mortality were performed.
During the study period, 16,960 patients underwent cancer surgery of the liver (n = 9,381) or pancreas (n = 7,579). The 90-day postoperative rate of venous thromboembolism was 6.1% (cancer surgery of the liver) and 6.7% (cancer surgery of the pancreas). Main risk factors of 90-day postoperative rate of venous thromboembolism were major hepatectomy (1.85; 1.55-2.21), left pancreatectomy (1.45; 1.18-1.79), presence of obesity (1.41; 1.16-1.71), history of venous thromboembolism (4.58; 3.41-6.14), open approach (1.31; 1.06-1.62), and the occurrence of serious surgical complication (1.55; 1.35-1.79). At 1 year, patients undergoing cancer surgery of the liver were at a lower risk of cumulative incidence (%) of venous thromboembolism compared with the cancer surgery of the pancreas group (P < .001) (7.0; 6.5-7.6 vs 9.8; 9.1-10.4). Patients with venous thromboembolism within 1 year had greater risks of 1-year global mortality for each hepatopancreatobiliary surgery group: 3.58 (95% confidence interval, 3.02-4.23) and 3.97 (95% confidence interval, 3.40-4.63), respectively.
Postoperative venous thromboembolism is a significant issue after hepatopancreatobiliary surgery, within 90 days postoperatively and up to 1 year, with the cancer surgery of the pancreas group being particularly at risk. A greater risk of global mortality within 1 year for patients experiencing early or late venous thromboembolism was found.
静脉血栓栓塞是肝胰胆手术后一种公认的并发症。然而，关于肝胰胆手术患者术后1年内危险因素和发病率的全国性数据较少。
这项基于全国观察性人群的队列研究使用了2015年1月1日至2017年12月31日期间法国所有接受肝脏和胰腺癌症手术患者的数据。对术后1年静脉血栓栓塞的累积发病率进行了估计，并对1年总体死亡率进行了Cox比例风险模型分析。
在研究期间，16960例患者接受了肝脏（n = 9381）或胰腺（n = 7579）癌症手术。术后90天静脉血栓栓塞发生率分别为肝脏癌症手术6.1%和胰腺癌症手术6.7%。术后90天静脉血栓栓塞发生率的主要危险因素包括肝大部切除术（1.85；1.55 - 2.21）、胰体尾切除术（1.45；1.18 - 1.79）、肥胖（1.41；1.16 - 1.71）、静脉血栓栓塞病史（4.58；3.41 - 6.14）、开放手术方式（1.31；1.06 - 1.62）以及严重手术并发症的发生（1.55；1.35 - 1.79）。1年时，与胰腺癌症手术组相比，肝脏癌症手术患者静脉血栓栓塞累积发病率（%）风险较低（P <.001）（7.0；6.5 - 7.6 vs 9.8；9.1 - 10.4）。肝胰胆手术各亚组中，1年内发生静脉血栓栓塞的患者1年总体死亡风险更高：分别为肝脏癌症手术组3.58（95%置信区间，3.02 - 4.23）和胰腺癌症手术组3.97（95%置信区间，3.40 - 4.63）。
术后静脉血栓栓塞是肝胰胆手术后一个重要问题，在术后90天内及长达1年期间均存在，其中胰腺癌症手术组风险尤其高。研究发现，早期或晚期发生静脉血栓栓塞的患者1年内总体死亡风险更高。
