title: Venous thromboembolism in patients receiving multimodality therapy for thoracic malignancies.
abstract: 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.
authors: Toronto General Hospital and Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada.
authors: Apurva
authors: A
authors: Patel
authors: Masaki
authors: M
authors: Anraku
authors: Gail E
authors: GE
authors: Darling
authors: Frances A
authors: FA
authors: Shepherd
authors: Andrew F
authors: AF
authors: Pierre
authors: Thomas K
authors: TK
authors: Waddell
authors: Shaf
authors: S
authors: Keshavjee
authors: Marc
authors: M
authors: de Perrot
mesh_terms: 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*