Construction and Validation of a Nomogram for Predicting the Risk of Deep Vein Thrombosis in Hepatocellular Carcinoma Patients After Laparoscopic Hepatectomy: A Retrospective Study

Abstract

Background:The incidence of deep vein thrombosis (DVT) in hepatocellular carcinoma (HCC) patients after laparoscopic hepatectomy (LH) is unclear, and there is no effective method for DVT risk assessment in these patients. Methods: The data from the total of 355 consecutive HCC patients who underwent LH were included. A DVT risk algorithm was developed using a training set (TS) of 243 patients, and its predictive performance was evaluated in both the TS and a validation set (VS) of 112 patients. The model was then used to develop a DVT risk nomogram (TRN). Results: The incidence of DVT in the present study was 18.6%. Age, sex, body mass index (BMI), comorbidities and operative position were independent risk factors for DVT in the TS. The model based on these factors had a good predictive ability. In the TS, it had an area under the receiver operating characteristic (AUC) curve of 0.861, Hosmer-Lemeshow (H-L) goodness of fit p value of 0.626, sensitivity of 44.4%, specificity of 96.5%, positive predictive value (PPV) of 74.1%, negative predictive value (NPV) of 88.4%, and accuracy of 86.8%. In the VS, it had an AUC of 0.818, H-L p value of 0.259, sensitivity of 38.1%, specificity of 98.9%, PPV of 88.9%, NPV of 87.4%, and accuracy of 87.5%. The TRN performed well in both the internal and the external validation, indicating a good clinical application value. The TRN had a better predictive value of DVT than the Caprini score (p < 0.001). Conclusion:The incidence of DVT after LH was high, and should not be neglected in HCC patients. The TRN provides an efficacious method for DVT risk evaluation and individualized pharmacological thromboprophylaxis.

Perioperative Coagulation Profile in Major Liver Resection for Cancer: A Prospective Observational Study

“…Consequently, identification of patients at higher thrombotic/haemorrhagic risk after liver cancer surgery is of paramount importance. Deep vein thrombosis risk nomograms for early identification of high-risk patients, 48 as well as point of care coagulation testing in the early post-operative period have been suggested for guiding individual treatment in clinical practice. Viscoelastic tests and global assays of haemostasis (TGA, thromboelastometry, thromboelastography) have been used for this reason.…”

Haemostatic alterations in patients with cirrhosis and hepatocellular carcinoma: laboratory evidence and clinical implications

“…89 However, it should be noted that these events were asymptomatic, mostly isolated to distal vessels, and detected early after surgery at scheduled ultrasound follow-up. 89 Therefore, the clinical significance of these events postremains is uncertain.…”

“…In a recent retrospective study in 355 HCC who underwent laparoscopic resection and did not receive thromboprophylaxis after surgery, 66 (18.6%) developed DVT 89 . However, it should be noted that these events were asymptomatic, mostly isolated to distal vessels, and detected early after surgery at scheduled ultrasound follow‐up 89 . Therefore, the clinical significance of these events post‐remains is uncertain.…”

“…101 Another recent retrospective study showed that the risk of DVT in patients with HCC who underwent laparoscopic liver resection and were not treated with anticoagulation was 18.6% (66/355). 89 These events were asymptomatic, predominantly distal and detected early after surgery, therefore their clinical significance remains uncertain. However, these results confirm that post-operative prophylaxis is required in patients with HCC who undergo liver resection.…”

“…Interestingly, the same study found that age, sex, body mass index, comorbidities and lateral vs supine position during surgery were independent predictors of DVT, and proposed to combine such variables into a predictive score which had a higher predictive capacity than that of Caprini score. 89 Per the most recent clinical guidelines, all patients with malig- On the other hand, there is currently no evidence supporting the use of primary prophylaxis to prevent VTE in outpatients with cirrhosis and HCC. The only evidence we currently have is that HCC is associated with an intermediate risk of thrombotic complications and that thromboprophylaxis with traditional anticoagulants such as low-molecular weight heparin or fondaparinux in hospitalized patients with cirrhosis has proven safe.…”