Comment On: The Duration and Magnitude of Postdischarge Venous Thromboembolism Following Colectomy : Annals of Surgery Open

Secondary Logo

Journal Logo

Letter to the Editor

Comment On: The Duration and Magnitude of Postdischarge Venous Thromboembolism Following Colectomy

Liang, Yi-di MD*; Liu, Kai MD, PhD

Author Information
Annals of Surgery Open 3(4):p e220, December 2022. | DOI: 10.1097/AS9.0000000000000220
  • Open

To the editor:

Venous thromboembolism (VTE) was a common cause of surgical morbidity and mortality. The recent study from Lewis-Lloyd et al investigated the impact of current guidelines by reporting weekly postoperative postdischarge VTE rates among patients following colectomy.1 As we all know that patients with cancer had a significantly increased risk of VTE, especially for patients after neoadjuvant chemotherapy (NACT).2 In the consideration of increasing trend of VTE among cancer patients and the more extensive utilization of NACT, this correspondence was designed to elucidate the risk of VTE among cancer patients after NACT and surgical resection.

We conducted a pooled analysis for gastrointestinal cancer patients after NACT and subsequent surgical resection. The results were mainly from 3 large sample-sized cohort studies and a meta-analysis.2–5 The rate of VET among gastrointestinal cancer patients who underwent NACT and surgery in these 4 studies were listed in Table 1. Our analysis indicated that the rate of VTE among patients with gastrointestinal cancer after NACT and surgical resection was 9.6% (180/1882) in 3 cohort studies and 5.5% (327/5956) in the meta-analysis, respectively. The total rate of VTE in our pooled analysis was 6.5% (507/7838) which was higher than the report from Wang et al (4.17%, 73/1750).2 For cancer patients who underwent NACT, the risk of VTE illustrated a dramatic increased trend, this result also indicate that the malignancies and chemotherapy were 2 notable risk factors of VTE.

TABLE 1. - Four Studies on Risk of VTE Among Gastrointestinal Cancer Patients After NACT and Surgical Resection
Author Year Study Periods Country Cases Median Follow-up Period VTE (N) VTE (%)
Mulder et al 2 2020 2011–2018 Netherlands 511 30 days 50 9.78
Slagter et al 3 2020 2015–2018 Netherlands 781 30 days 78 9.99
Papaxoinis et al 4 2018 2009–2017 Unite Kingdom 590 30 days 52 8.81
Di Nisio et al 5 2018 2005–2017 Italy 5956 30 days 327 5.48
NACT indicates neoadjuvant chemotherapy; VTE, venous thromboembolism.

The recent study from Lewis-Lloyd et al indicated the emergency benign colectomy patients may benefit from extended VTE prophylaxis. However, the rate of VTE after NACT was not involved in this study, and no association was uncovered between adjuvant chemotherapy and VTE. Combined with our analysis, the NACT might also lead to higher risk of VTE among gastrointestinal cancer patients. Therefore, we upheld that long-term prophylactic anticoagulation should be applied to gastrointestinal cancer patients after NACT and surgical resection. The early on-set surveillance by ultrasonography for VTE after NACT and cancer surgery should be also recommended to decrease the risk of pulmonary embolism and avoid serious consequences. In addition, the long-term prophylactic anticoagulation and VTE screening program should be conducted on gastrointestinal cancer patients who underwent NACT. The More community hospitals should be encouraged to enhance propaganda and education concerned long-term prophylactic anticoagulation to reduce the morbidity and mortality. The associative mechanism between medical centers and vicinal community hospitals should be established to proceed the prophylactic anticoagulation and VTE evaluation.

In our opinion, patients underwent NACT and subsequent cancer surgery would suffer an extreme high risk of VTE. Therefore, not only the perioperative prophylactic anticoagulation should be routinely performed, but also the sequential prophylactic anticoagulation after hospital discharge should be taken into account by clinicians.

REFERENCES

1. Lewis-Lloyd CA, Humes DJ, West J, et al. The duration and magnitude of postdischarge venous thromboembolism following colectomy. Ann Surg. 276: e177–e184.
2. Mulder FI, Hovenkamp A, van Laarhoven HWM, et al. Thromboembolic and bleeding complications in patients with oesophageal cancer. Br J Surg. 2020;107:1324–1333.
3. Slagter AE, Sikorska K, Grootscholten C, et al. Venous thromboembolism during preoperative chemotherapy in the CRITICS gastric cancer trial. Cancer Med. 2020;9:6609–6616.
4. Papaxoinis G, Kamposioras K, Germetaki T, et al. Predictive factors of thromboembolic complications in patients with esophagogatric adenocarcinoma undergoing preoperative chemotherapy. Acta Oncol. 2018;57:790–798.
5. Di Nisio M, Candeloro M, Rutjes AWS, et al. Venous thromboembolism in cancer patients receiving neoadjuvant chemotherapy: a systematic review and meta-analysis. J Thromb Haemost. 2018;16:1336–1346.
Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc.