Venous thromboembolism in patients receiving multimodality therapy for thoracic malignancies.
OBJECTIVE
The rate of venous thromboembolism in patients undergoing multimodality therapy for lung malignancy and the impact of preoperative venous thromboembolism on postoperative outcome have not been analyzed systematically.


METHODS
We performed a retrospective review of all patients undergoing induction therapy before lung resection for non-small cell lung cancer and malignant pleural mesothelioma at the University Health Network between January 1996 and December 2007.


RESULTS
Venous thromboembolism developed in 23 (12.3%) of 186 patients undergoing induction therapy. The venous thromboembolism was diagnosed during induction therapy in 11 patients. The proportion of pulmonary embolism was higher during induction therapy (9/11 patients), whereas deep venous thromboses were observed predominantly postoperatively (7/12 patients) (P = .02). The risk of postoperative complications or death was not increased in patients undergoing surgery despite a preoperative diagnosis of venous thromboembolism. However, the risk of postoperative pulmonary embolism was higher in patients undergoing surgery without insertion of an inferior vena cava filter (1/2 patients vs 0/7 after insertion of an inferior vena cava filter, P = .047). The overall survival was similar between patients with or without venous thromboembolism complications.


CONCLUSIONS
This study demonstrates that venous thromboembolism events in patients undergoing multimodality therapy for lung malignancies is high and deserves careful consideration. Patients with a venous thromboembolism diagnosis during induction therapy may potentially benefit from a temporary inferior vena cava filter before surgery to limit the risk of recurrent pulmonary embolism. A preoperative diagnosis of venous thromboembolism, however, does not affect early and late outcomes after surgery and should not be viewed as a negative prognostic marker.
Patel
Apurva
A
Toronto General Hospital and Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada.
Anraku
Masaki
M
Darling
Gail E
GE
Shepherd
Frances A
FA
Pierre
Andrew F
AF
Waddell
Thomas K
TK
Keshavjee
Shaf
S
de Perrot
Marc
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000628:therapy*; D008297:Male; D008654:Mesothelioma / Q000401:mortality / Q000628:therapy*; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000009:adverse effects; D010997:Pleural Neoplasms / Q000401:mortality / Q000628:therapy*; D011183:Postoperative Complications; D011655:Pulmonary Embolism / Q000209:etiology; D012307:Risk Factors; D015996:Survival Rate; D014682:Vena Cava, Inferior; D054556:Venous Thromboembolism / Q000209:etiology*