Ovarian vein thrombosis after debulking surgery for ovarian cancer: epidemiology and clinical significance.
OBJECTIVE
Ovarian vein thrombosis is associated with pregnancy and pelvic surgery. Postpartum ovarian vein thrombosis is associated with infection and a high morbidity rate and is treated with anticoagulant and intravenous antibiotic therapy. The natural history of such thrombotic events after debulking surgery for ovarian cancer has not been well described. Our objective was to characterize the presentation and outcomes for patients with this condition at our institution.


METHODS
We conducted a retrospective study of patients who underwent surgical debulking for ovarian cancer at Memorial Sloan Kettering Cancer Center between the years 2001 and 2010. Patients were included if contrast computed tomography scans of both the abdomen and pelvis were performed within 12 weeks before and 12 weeks after the surgery. The images were reviewed to assess for the presence and extent of a new postoperative ovarian vein thrombosis. When available, subsequent studies were assessed for thrombus progression. Medical records were reviewed to determine whether anticoagulation was used for treatment of the thrombotic episode and to record the occurrence of any new significant venous thromboembolic event in the next year.


RESULTS
One hundred fifty-nine patients had satisfactory imaging. New ovarian vein thrombosis was a common complication of debulking surgery, as found in 41 of patients (25.8%). Only 5 women with ovarian vein thrombosis were started on anticoagulation, of which 2 individuals had an independent venous thromboembolic event as indication for treatment. Only 2 of the ovarian vein thromboses (4.9%) progressed to the inferior vena cava or left renal vein on subsequent scan. The estimated cumulative incidence of venous thromboembolism 1 year after the first postoperative scan was 17.1% for patients in the new ovarian vein thrombosis group vs 15.3% of individuals for the group without a postoperative ovarian vein thrombosis (P = .78).


CONCLUSIONS
Ovarian vein thrombosis is commonly encountered after debulking surgery for ovarian cancer. Anticoagulation is usually not indicated, and clinically meaningful thrombus progression rarely occurs.
Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY. Electronic address: manthas@mskcc.org.
Simon
S
Mantha
Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY.
Debra
D
Sarasohn
Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY.
Weining
W
Ma
Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY.
Sean M
SM
Devlin
Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
Dennis S
DS
Chi
Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD.
Kara Long
KL
Roche
Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
Rudy S
RS
Suidan
Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY.
Kaitlin
K
Woo
Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.
Gerald A
GA
Soff
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D016022:Case-Control Studies; D065426:Cytoreduction Surgical Procedures; D018450:Disease Progression; D005260:Female; D006801:Humans; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000601:surgery*; D010053:Ovary / Q000098:blood supply*; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000453:epidemiology*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000453:epidemiology*; D055815:Young Adult
D000925:Anticoagulants
debulking surgery; ovarian cancer; ovarian vein thrombosis