Incidence of pulmonary thromboembolism in gastric cancer surgery using routine thromboprophylaxis.
BACKGROUND
There is a lack of published data on the incidence of pulmonary thromboembolism (PTE) after resections for gastric cancer. We report the incidence of PTE after gastric cancer surgery with routine thromboprophylaxis from a high-volume center.


METHODS
Between October 2002 and December 2008, 3262 patients underwent gastric cancer surgery with routine thromboprophylaxis using low-dose unfractionated heparin, intermittent pneumatic compression, fluid infusion, and graduated compression stockings. Patients diagnosed with PTE were identified from a prospectively collected database that included complications related to thromboprophylaxis.


RESULTS
Seven patients (0.2%) developed symptomatic PTE in this series. Multivariate analysis demonstrated that female sex (P = 0.029) and high body mass index (P = 0.025) were significant risk factors for PTE. The most common symptom was dyspnea (57%). Five patients (71%) developed PTE by the second postoperative day. All patients were treated successfully with medical treatment and no hospital deaths were recorded. Adverse events related to thromboprophylaxis included major postoperative bleeding in 10 (0.3%) of the 3262 patients. There were no cases of hematoma related to the insertion of epidural catheters for analgesia.


CONCLUSIONS
The routine use of thromboprophylaxis in Japanese patients undergoing gastric resection is safe and effective in reducing the incidence of pulmonary thromboembolism.
Saka
Makoto
M
Gastric Surgery Division, National Cancer Center Hospital, Chuo-ku, Tokyo, 104-0045, Japan.
Morita
Shinji
S
Fukagawa
Takeo
T
Nijjar
Rajwinder
R
Katai
Hitoshi
H
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D016208:Databases, Factual; D005260:Female; D006493:Heparin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D048228:Intermittent Pneumatic Compression Devices; D007564:Japan; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology* / Q000517:prevention & control; D019106:Postoperative Hemorrhage / Q000209:etiology; D011655:Pulmonary Embolism / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D012307:Risk Factors; D053828:Stockings, Compression; D013274:Stomach Neoplasms / Q000601:surgery*; D055815:Young Adult
D000925:Anticoagulants; D006493:Heparin