title: Is venous thromboprophylaxis necessary in patients undergoing minimally invasive surgery for a gynecologic malignancy?
abstract: OBJECTIVE
  Current recommendations for the use of venous thromboprophylaxis in patients undergoing minimally invasive surgery (MIS) for a gynecologic malignancy are derived from patients undergoing open surgery. Our objective was to determine the 30-day prevalence of symptomatic venous thromboembolism (VTE) after laparoscopic gynecologic oncology procedures in patients who received no thromboprophylaxis.
  
  
  METHODS
  Between January 2006 and September 2013, women who underwent MIS for endometrial, cervical or ovarian cancer at a single institution were included. Data on patient demographics, diagnosis, comorbidities, perioperative characteristics, use of thromboprophylaxis, and diagnosis of VTE were collected retrospectively.
  
  
  RESULTS
  Of the 419 patients who underwent MIS for a gynecologic cancer, 352 (84%) received no VTE prophylaxis. At least a total laparoscopic hysterectomy (simple or radical) or pelvic lymph node dissection was performed in 95% of these patients. The median length of surgery was 137 min and 95% of patients were discharged home within 1 day of surgery. The rate of VTE in the 352 untreated patients was 0.57% (1 pulmonary embolism and 1 deep vein thrombosis). There were no VTE diagnosed within 30 days of surgery in the 67 patients who received anticoagulant thromboprophylaxis.
  
  
  CONCLUSIONS
  The rate of VTE is low in patients undergoing minimally invasive surgery for a gynecologic malignancy despite no VTE prophylaxis. The benefits of routine use of VTE prophylaxis in this population are questionable.
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada.
authors.forename: Geneviève
authors.initials: G
authors.lastname: Bouchard-Fortier
authors.affiliation: Thromboembolism Program, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada.
authors.forename: William H
authors.initials: WH
authors.lastname: Geerts
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada; Division of Gynecologic Oncology, Odette Cancer Centre, University of Toronto, Toronto, Canada.
authors.forename: Allan
authors.initials: A
authors.lastname: Covens
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada; Division of Gynecologic Oncology, Odette Cancer Centre, University of Toronto, Toronto, Canada.
authors.forename: Danielle
authors.initials: D
authors.lastname: Vicus
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada; Division of Gynecologic Oncology, Odette Cancer Centre, University of Toronto, Toronto, Canada.
authors.forename: Rachel
authors.initials: R
authors.lastname: Kupets
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada; Division of Gynecologic Oncology, Odette Cancer Centre, University of Toronto, Toronto, Canada. Electronic address: lilian.gien@sunnybrook.ca.
authors.forename: Lilian T
authors.initials: LT
authors.lastname: Gien
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005833:Genital Neoplasms, Female / Q000601:surgery*; D013509:Gynecologic Surgical Procedures / Q000379:methods; D006801:Humans; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control*; D015995:Prevalence; D012189:Retrospective Studies; D013997:Time Factors; D054556:Venous Thromboembolism / Q000453:epidemiology / Q000517:prevention & control*; D055815:Young Adult
keywords: Gynecologic malignancies; Minimally invasive surgery; Thromboprophylaxis; Venous thromboembolism