Incidence and Risk Factors Related to Symptomatic Venous Thromboembolic Events After Esophagectomy for Cancer.
BACKGROUND
Major oncologic surgery is associated with a high incidence of venous thromboembolic events (VTE), including deep venous thrombosis (DVT) and pulmonary embolism (PE). However, the incidence and risk factors for symptomatic VTE during curative treatment for patients with esophageal cancer are poorly documented.


METHODS
Data were collected from 30 European centers from 2000 to 2010. The incidence of in-hospital VTE was assessed in 2,944 patients with esophageal cancer having surgery with curative intent, and 50 clinically relevant parameters were assessed as potential risk factors for VTE. Patients received low molecular weight heparin prophylaxis during hospital stay and for 4 weeks after surgery.


RESULTS
Eighty-four patients (2.9%) developed a symptomatic VTE; all of them had a DVT and 44 were also diagnosed with a PE. In the VTE group there were 19 postoperative deaths recorded, 5 of which (26.3%) were directly caused by PE at postoperative days 7, 10, 21, 45, and 48 despite VTE prophylaxis. In-hospital postoperative mortality was significantly higher in VTE patients (23% versus 7%, p < 0.001) and mean hospital stay was also longer in this group (33 ± 24 versus 25 ± 21 days, p < 0.001). Multivariable analysis showed that high American Society of Anesthesiologists (ASA) class (p = 0.008), pneumopathy (p = 0.002), or an acute respiratory distress syndrome (ARDS) (p = 0.015) were significantly associated with VTE.


CONCLUSIONS
Patients with ASA class III or IV and those who present a postoperative pneumopathy or ARDS seem to be at higher risk for VTE. Thus, current VTE screening and thromboprophylaxis for these patients might be inadequate and needs further investigation.
Department of Visceral Surgery, Lausanne University Hospital, Switzerland.
Styliani
S
Mantziari
Department of Digestive and Oncological Surgery, Louis Mourier University Hospital, Colombes, France.
Caroline
C
Gronnier
Department of Digestive Surgery, Edouard Herriot University Hospital, Lyon, France.
Arnaud
A
Pasquer
Department of Digestive Surgery, Estaing University Hospital, Clermont-Ferrand, France.
Johan
J
Gagnière
Department of Digestive Surgery, Cavale Blanche University Hospital, Brest, France.
Jérémie
J
Théreaux
Department of Visceral Surgery, Lausanne University Hospital, Switzerland.
Nicolas
N
Demartines
Department of Visceral Surgery, Lausanne University Hospital, Switzerland.
Markus
M
Schäfer
Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, Lille, France. Electronic address: christophe.mariette@chru-lille.fr.
Christophe
C
Mariette
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D012307:Risk Factors; D054556:Venous Thromboembolism / Q000453:epidemiology* / Q000209:etiology