Incidence, risk profile and morphological pattern of lower extremity venous thromboembolism after urological cancer surgery.
OBJECTIVE
We examined the incidence of asymptomatic and symptomatic lower extremity venous thromboembolism in patients who underwent urological surgery for cancer, and identified preoperative and operative risk factors predictive of the thromboembolism.


METHODS
A cohort of 583 consecutive patients undergoing urological cancer surgery was prospectively assessed using complete lower limb ultrasound at postoperative day 7 from January 2005 to July 2009. In all patients heparin and mechanical thromboprophylaxis were prescribed until complete ambulation. Potential variables predictive of venous thrombosis were analyzed.


RESULTS
Complete data were available in 538 patients (463 male and 75 female), of whom 177 underwent nephrectomy, 86 radical cystectomy and 275 radical prostatectomy. A total of 40 deep venous thrombosis cases were found (7.4%), most of which were asymptomatic (92%) and limited to deep calf veins (80%). Of those asymptomatic deep venous thrombosis cases 86% were limited to deep calf veins. In all, 12 pulmonary embolisms were diagnosed, of which 4 were lethal. On multivariate analysis history of venous thromboembolism (OR 5.16, p = 0.02) and radical cystectomy (OR 3.47, p = 0.002) were independently associated with venous thromboembolism.


CONCLUSIONS
Lower extremity venous thromboembolism has a high rate of occurrence after urological surgery for cancer despite the recommended venous thromboembolism prophylaxis. Most cases are asymptomatic and limited to deep calf veins. Our results suggest that complete lower limb ultrasound should be performed early after radical cystectomy and in patients with a personal history of venous thromboembolism.
Department of Urology, North Hospital, Marseille, France. christophe.clement@ap-hm.fr
Christophe
C
Clément
Pascal
P
Rossi
Karim
K
Aissi
Pierre
P
Barthelemy
Nicolas
N
Guibert
Pascal
P
Auquier
Evelyne
E
Ragni
Dominique
D
Rossi
Yves
Y
Frances
Cyrille
C
Bastide
D015653:Cystectomy; D005260:Female; D006801:Humans; D015994:Incidence; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D011183:Postoperative Complications / Q000453:epidemiology* / Q000473:pathology; D011446:Prospective Studies; D011468:Prostatectomy; D012307:Risk Factors; D014571:Urologic Neoplasms / Q000601:surgery; D054556:Venous Thromboembolism / Q000453:epidemiology* / Q000473:pathology