title: Thromboembolic events before esophagectomy for esophageal cancer do not result in worse outcomes.
abstract: BACKGROUND
  Esophageal cancer, chemotherapy, and radiation are all associated with an increased incidence of thromboembolic events (TEE). Development of a TEE during neoadjuvant treatment for esophageal cancer can alter the treatment course, as surgery may be delayed or cancelled because patients require anticoagulation therapy. We evaluated the incidence of preoperative TEE among esophageal cancer patients undergoing neoadjuvant treatment and the impact on morbidity, mortality, and timing of surgery.
  
  
  METHODS
  We performed a retrospective review of a prospectively collected database of 1,057 patients who underwent esophagectomy for esophageal cancer between January 1999 and May 2010. Of these patients, 534 were treated with neoadjuvant chemotherapy and radiation.
  
  
  RESULTS
  Preoperative thromboembolic events occurred in 75 of 534 patients (14.0%). The only preoperative factor associated with increased risk of TEE was increased preoperative weight (p=0.02). Fluorouracil significantly increased the risk of TEE (p=0.028, odds ratio 2.12, 95% confidence interval: 1.09 to 4.26), whereas there was no difference in patients receiving cisplatin (p=0.299). There was a trend toward an association between infectious complications during neoadjuvant therapy and TEE development (p=0.076). Patients with TEEs had a delay from neoadjuvant therapy to surgery (p=0.0004). The TEE group had a trend toward the increased onset of postoperative atrial fibrillation (p=0.0688, odds ratio 1.77, 95% confidence interval: 0.96 to 3.27). There was no difference in respiratory complications (p=0.934), overall complications (p=0.859), 30-day mortality (p=0.899), or overall survival (p=0.790).
  
  
  CONCLUSIONS
  Thromboembolic events in the preoperative period delay the time to surgery for patients with esophageal cancer. Despite this delay, there is no demonstrable effect on postoperative complications or mortality.
authors.affiliation: Section of Thoracic Surgery, Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan 48109, USA.
authors.forename: Nicholas R
authors.initials: NR
authors.lastname: Teman
authors.forename: Latifa
authors.initials: L
authors.lastname: Silski
authors.forename: Lili
authors.initials: L
authors.lastname: Zhao
authors.forename: Maggie
authors.initials: M
authors.lastname: Kober
authors.forename: Susan C
authors.initials: SC
authors.lastname: Urba
authors.forename: Mark B
authors.initials: MB
authors.lastname: Orringer
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Chang
authors.forename: Jules
authors.initials: J
authors.lastname: Lin
authors.forename: Rishindra M
authors.initials: RM
authors.lastname: Reddy
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D059186:Chemoradiotherapy, Adjuvant / Q000009:adverse effects; D004938:Esophageal Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy / Q000601:surgery; D016629:Esophagectomy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000009:adverse effects; D011300:Preoperative Care / Q000009:adverse effects*; D057234:Preoperative Period; D011379:Prognosis; D012189:Retrospective Studies; D013923:Thromboembolism / Q000453:epidemiology* / Q000209:etiology
chemical_list: D000970:Antineoplastic Agents