Skip to main content

Advertisement

SpringerLink
Log in

Incidence, Risk Factors, and Prevention Strategies for Venous Thromboembolism after Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy

  • Peritoneal Surface Malignancy
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The risk factors and incidence of venous thromboembolism (VTE) are not well defined in patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC). We sought to characterize the incidence, risk factors, and pharmacothromboprophylaxis strategies for VTE after CRS/HIPEC.

Patients and Methods

We performed a retrospective study of CRS/HIPEC procedures at our institution from 8/2007 to 11/2017, examining the 60-day VTE incidence. Baseline, potential risk factor, and prevention strategy data were collected. Univariate and multivariate regression analysis was used to determine risk factors associated with 60-day VTEs.

Results

We identified 25 60-day VTEs among 447 CRS/HIPEC procedures (5.6%). VTEs were discovered on median postoperative day 20 (range 2–59); pulmonary emboli (68%) were the most common type of VTE. The 60-day VTE rate was 10.2% before versus 4.9% after initiation of a policy to discharge patients on pharmacothromboprophylaxis (p = 0.10). Patients with 60-day VTEs had longer average length of stay (14 vs. 11 days, p = 0.01) and higher 60-day mortality rate (4% vs. 0.2%, p = 0.02) than those without VTEs. Caprini score (odds ratio [OR] 1.53, 95% confidence interval [CI] 1.10–2.15, p = 0.01), preoperative serum albumin level (OR 0.40, 95% CI 0.16–1.00, p = 0.05), and 60-day non-VTE serious morbidity (OR 3.45, 95% CI 1.25–9.51, p = 0.02) were risk factors associated with 60-day VTEs on multivariate analysis.

Conclusions

VTEs are relatively common after CRS/HIPEC and are associated with high Caprini scores, low serum albumin levels, and additional inpatient comorbidities. They result in longer length of stay and higher mortality rate. Compliance with current guidelines for extended postoperative thromboprophylaxis was likely associated with reduced VTE rate.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Bellini G, Teng A, Kotecha N, Sutton E, Yang CK, Passeri M, et al. The identification of risk factors for venous thromboembolism in gastrointestinal oncologic surgery. J Surg Res. 2016;205(2):279–85.

    Article  PubMed  Google Scholar 

  2. Gould MK, Garcia DA, Wren SM, Karanicolas PJ, Arcelus JI, Heit JA, et al. Prevention of VTE in nonorthopedic surgical patients: antithrombotic therapy and prevention of thrombosis, 9th ed: American. Chest. 2012;141(2 Suppl):e227S–77S.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Baumgartner JM, McKenzie S, Block S, Costantini TW, Lowy AM. Prophylactic enoxaparin doses may be inadequate in patients undergoing abdominal cancer surgery. J Surg Res. 2018;221:183–89.

    Article  CAS  PubMed  Google Scholar 

  4. Becattini C, Rondelli F, Vedovati MC, Camporese G, Giustozzi M, Boncompagni M, et al. Incidence and risk factors for venous thromboembolism after laparoscopic surgery for colorectal cancer. Haematologica. 2015;100(1):e35–8.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Khalil J, Bensaid B, Elkacemi H, Afif M, Bensaid Y, Kebdani T, et al. Venous thromboembolism in cancer patients: an underestimated major health problem. World J Surg Oncol. 2015;13:204–220.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Alsubaie H, Leggett C, Lambert P, Park J, Hochman D, Wirtzfeld D, et al. Diagnosis of VTE postdischarge for major abdominal and pelvic oncologic surgery: implications for a change in practice. Can J Surg. 2015;58(5):305–11.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Lanuke K, Mack LA, Temple WJ. A prospective evaluation of venous thromboembolism in patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Can J Surg. 2009;52(1):18–22.

    PubMed  PubMed Central  Google Scholar 

  8. Osborne NH, Wakefield TW, Henke PK. Venous thromboembolism in cancer patients undergoing major surgery. Ann Surg Oncol. 2008;15(12):3567–78.

    Article  PubMed  Google Scholar 

  9. Wun T, White RH. Epidemiology of cancer-related venous thromboembolism. Best Pract Res Clin Haematol. 2009;22(1):9–23.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Foster JM, Sleightholm R, Watley D, Wahlmeier S, Patel A. The efficacy of dextran-40 as a venous thromboembolism prophylaxis strategy in cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Am Surg. 2017;83(2):134–40.

    PubMed  Google Scholar 

  11. Spiliotis J, Halkia E, de Bree E. Treatment of peritoneal surface malignancies with hyperthermic intraperitoneal chemotherapy-current perspectives. Curr Oncol. 2016;23(3):e266–75.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Lyman GH, Bohlke K, Khorana AA, Kuderer NM, Lee AY, Arcelus JI, et al. Venous thromboembolism prophylaxis and treatment in patients with cancer: american society of clinical oncology clinical practice guideline update 2014. J Clin Oncol. 2015;33(6):654–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Razavi SA, Styblo TM, Sarmiento JM, Kooby DA, Sullivan PS, Maithel S, et al. Despite guidelines, preoperative administration of subcutaneous heparin for venous thromboembolism prophylaxis is severely underutilized. J Am Coll Surg. 2016;223(4):S140.

    Article  Google Scholar 

  14. Vukadinovic V, Chiou JD, Morris DL. Clinical features of pulmonary emboli in patients following cytoreductive surgery (peritonectomy) and hyperthermic intraperitoneal chemotherapy (hipec), a single centre experience. Eur J Surg Oncol. 2015;41(5):702–6.

    Article  CAS  PubMed  Google Scholar 

  15. Rottenstreich A, Gilly FN, Boutitie F, Bereder JM, Quenet F, Sideris L, et al. Factors associated with thromboembolic events following cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. J Surg Oncol. 2017;116(7):914–20.

    Article  CAS  PubMed  Google Scholar 

  16. Baumgartner JM, Tobin L, Heavey SF, Kelly KJ, Roeland EJ, Lowy AM. Predictors of progression in high-grade appendiceal or colorectal peritoneal carcinomatosis after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy. Ann Surg Oncol. 2015;22(5):1716–21.

    Article  PubMed  Google Scholar 

  17. Portilla AG, Shigeki K, Dario B, Marcello D. The intraoperative staging systems in the management of peritoneal surface malignancy. J Surg Oncol. 2008;98(4):228–31.

    Article  PubMed  Google Scholar 

  18. Sugarbaker PH. Successful management of microscopic residual disease in large bowel cancer. Cancer Chemother Pharmacol. 1999;43 Suppl:S15–25.

    Article  PubMed  Google Scholar 

  19. Caprini JA. Thrombosis risk assessment as a guide to quality patient care. Dis Mon. 2005;51(2–3):70–8.

    Article  PubMed  Google Scholar 

  20. Serrano PE, Parpia S, Linkins LA, Elit L, Simunovic M, Ruo L, et al. Venous thromboembolic events following major pelvic and abdominal surgeries for cancer: a prospective cohort study. Ann Surg Oncol. 2018;25(11):3214–21.

    Article  PubMed  Google Scholar 

  21. National Comprehensive Cancer Network (2019). Cancer-Associated Venous Thromboembolic Disease. https://www.nccn.org/professionals/physician_gls/pdf/vte.pdf. Accessed March 6, 2019.

  22. Bergqvist D, Agnelli G, Cohen AT, Eldor A, Nilsson PE, Le Moigne-Amrani A, et al. Duration of prophylaxis against venous thromboembolism with enoxaparin after surgery for cancer. N Engl J Med. 2002;346(13):975–80.

    Article  CAS  PubMed  Google Scholar 

  23. Folsom AR, Lutsey PL, Heckbert SR, Cushman M. Serum albumin and risk of venous thromboembolism. Thromb Haemost. 2010;104(1):100–4.

    CAS  PubMed  PubMed Central  Google Scholar 

  24. Ataseven, B., du Bois A, Reinthaller A, Traut A, Heitz F, Aust S, et al. Pre-operative serum albumin is associated with post-operative complication rate and overall survival in patients with epithelial ovarian cancer undergoing cytoreductive surgery. Gynecol Oncol. 2015;138(3):560–5.

    Article  CAS  PubMed  Google Scholar 

  25. Konigsbrugge O, Posch F, Riedl J, Reitter EM, Zielinski C, Pabinger I, et al. Association between decreased serum albumin with risk of venous thromboembolism and mortality in cancer patients. Oncologist. 2016;21(2):252–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Pannucci CJ, Bailey SH, Dreszer G, Wachtman CF, Zumsteg JW, Jaber RM, et al. Validation of the Caprini risk assessment model in plastic and reconstructive surgery patients. J Am Coll Surg. 2011;212(1):105–12.

    Article  PubMed  Google Scholar 

  27. Bahl V, Hu HM, Henke PK, Wakefield TW, Campbell Jr DA, Caprini JA. A validation study of a retrospective venous thromboembolism risk scoring method. Ann Surg. 2010;251(2):344–50.

    Article  PubMed  Google Scholar 

  28. Pannucci CJ, Fleming KI. Comparison of face-to-face interaction and the electronic medical record for venous thromboembolism risk stratification using the 2005 Caprini score. J Vasc Surg Venous Lymphat Disord. 2018;6(3):304–311.

    Article  PubMed  Google Scholar 

Download references

Acknowledgment

This study was supported by a UCSD Clinical and Translational Research Institute grant (UL1TR001442).

Author information

Authors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery, University of California San Diego, La Jolla, CA, USA

    Sohini Khan BS, Kaitlyn J. Kelly MD, Jula Veerapong MD, Andrew M. Lowy MD & Joel M. Baumgartner MD, MAS

Authors
  1. Sohini Khan BS
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kaitlyn J. Kelly MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jula Veerapong MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Andrew M. Lowy MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Joel M. Baumgartner MD, MAS
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Joel M. Baumgartner MD, MAS.

Ethics declarations

Disclosure

None.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (TIFF 42417 kb)

Supplementary material 2 (DOCX 12 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Khan, S., Kelly, K.J., Veerapong, J. et al. Incidence, Risk Factors, and Prevention Strategies for Venous Thromboembolism after Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy. Ann Surg Oncol 26, 2276–2284 (2019). https://doi.org/10.1245/s10434-019-07414-8

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-019-07414-8

Search

Navigation