title: A prospective evaluation of venous thromboembolism in patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.
abstract: BACKGROUND
  We sought to investigate the incidence of perioperative venous thromboembolism (VTE)--pulmonary embolism, superior mesenteris vein thrombosis and deep vein thrombosis--in patients with peritoneal carcinomatosis after cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy.
  
  
  METHODS
  We performed cytoreductive surgery and hyperthermic intraperitoneal chemotherapy on 60 consecutive patients with a mean age of 52 (range 24-76) years. We reviewed a prospective database recording complications and patient, tumour and surgical characteristics to determine the incidence of VTE. We reviewed hospital charts of patients with VTE to obtain clinical information including vital signs, risk factors, presence of comorbid conditions, VTE prophylaxis and subjective clinical symptoms.
  
  
  RESULTS
  A total of 6 of 60 patients (10%) who had cytoreductive surgery and hyperthermic intraperitoneal chemotherapy experienced VTE. All patients with VTE had extensive peritoneal disease and long durations of surgery: the median duration was 431 (range 330-683) minutes. Tachycardia (mean 104 beats/min) was the only consistent abnormal vital sign recorded, with only 33% of patients experiencing clinical symptoms.
  
  
  CONCLUSIONS
  This prospective study demonstrates a high rate of VTE in this patient population. Unfortunately, clinical signs and symptoms are a poor predictor of VTE. Therefore, routine screening of this specific population at high risk for VTE is warranted.
authors.affiliation: Department of Surgery, University of Calgary, Calgary, Alta.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Lanuke
authors.forename: Lloyd A
authors.initials: LA
authors.lastname: Mack
authors.forename: Walley J
authors.initials: WJ
authors.lastname: Temple
mesh_terms: D000230:Adenocarcinoma / Q000628:therapy; D000328:Adult; D000368:Aged; D017024:Chemotherapy, Adjuvant; D010478:Chemotherapy, Cancer, Regional Perfusion; D004067:Digestive System Neoplasms / Q000628:therapy*; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced; D015994:Incidence; D007263:Infusions, Parenteral; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011553:Pseudomyxoma Peritonei / Q000628:therapy; D011655:Pulmonary Embolism / Q000209:etiology*; D013610:Tachycardia / Q000209:etiology; D013997:Time Factors; D020246:Venous Thrombosis / Q000209:etiology*; D055815:Young Adult