A new study presented today at AATS 101st Annual Meeting found that the percentage of patients who will undergo postoperative oesophagectomy for cancer and have venous thromboembolism (VTE) postoperatively is much higher than previously reported, with up to 24 percent suffering from deep vein thrombosis (DVT) or pulmonary embolism (PE). The six-month mortality in patients with VTE was 17.6 percent versus 2.1 percent in patients without VTE.
Venous thromboembolism (VTE) is a common, potentially preventable postoperative complication that leads to significant morbidity and mortality. Due to the burden of disease, the extent of the operation, and the high rate of perioperative morbidity, patients with esophagectomy belong to the VTE risk groups. The study aimed to quantify the actual incidence of VTE after esophagectomy, the associated risk factors, and the impact of VTE on patient outcomes.
Patients who underwent oesophagectomy for malignancy in eight tertiary centers between November 2017 and March 2020 were included in a prospective cohort study. All patients received guideline-based VTE prophylaxis up to discharge from hospital and, before discharge, underwent bilateral venous Doppler sonography (DUS) of the lower extremities, followed by computed tomography pulmonary embolism (CT-PE) and DUS after 30 and 90 Days underwent postoperatively and DUS after 60 days. D-dimer levels were measured at each interval and patients were observed 6 months postoperatively.
According to Yaron Shargall, MD, FRCSC, professor and chair of the Department of Thoracic Surgery at McMaster University and study director, despite the fact that all patients were treated according to best practices with VTE prophylaxis, a high proportion would have been discharged home with VTE Standard protocols or would have developed VTE after discharge. “When we followed this cohort of patients for six months, we found that VTE events mostly developed within a month of surgery, but also within six months. More importantly, those who developed VTE a seven-fold increase The increase had mortality after six months, the reasons for which are yet to be determined, “says Shargall. “We have yet to define whether active screening for VTE in all patients with esophagectomy is really warranted and whether extending the duration of VTE prophylaxis beyond hospitalization will improve patient outcomes,” he added.
The panel notes that taking a 30-day course of VTE prophylaxis after discharge improves outcomes
“The contemporary importance of venous thromboembolism [Deep Venous Thrombosis (DVT) and Pulmonary Embolus (PE)] in patients undergoing esophagectomy: a prospective, multicenter cohort study to evaluate the incidence and clinical outcomes of VTE after major esophagectomy. “Presented by Dr. Esther Lau on May 1, 2021 at the 101st Annual Meeting of AATS.
Provided by the American Association for Thoracic Surgery
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