Impact of Antithrombotic Therapy on the Outcome of Patients Undergoing Laparoscopic Colorectal Cancer Surgery: A Systematic Literature Review

Abstract

In recent years, many operations have been performed as laparoscopic surgeries in the field of gastrointestinal surgery, but the effect of antithrombotic therapy (ATT) on hemorrhagic complications in patients who have undergone laparoscopic colorectal cancer surgery remains unknown. In addition, the efficacy and safety of pharmacotherapy for the prevention of venous thromboembolism (VTE) have not yet been concluded. The purpose of this systematic review study is to clarify the effect of ATT on hemorrhagic complications in patients undergoing laparoscopic colorectal cancer surgery. Articles published between 2013 and 2020 were searched on Google Scholar and PubMed, and research regarding ATT and laparoscopic colorectal cancer surgery was included after a thorough examination of each study. Each study yielded information on the study's design, type of surgical procedures, antithrombotic medications used, and surgical outcomes (both thromboembolic and hemorrhagic consequences). This systematic review comprised 20 published papers, including a total of 12,751 patients who received laparoscopic colorectal cancer surgery. Four studies on thrombosis prevention in VTE were randomized clinical trials, and the other 16 were cohort or case-control studies. For the effects of prolonged use of ATT on hemorrhagic complications, most studies demonstrated that laparoscopic colorectal cancer surgery with continued preoperative aspirin could be safely conducted without an increase in the frequency of bleeding complications. On the other hand, most included papers have shown that patients receiving VTE pharmacoprophylaxis may be at an increased risk of bleeding complications, but its effectiveness has not been statistically proven, especially in the Asian patient population. Laparoscopic colorectal cancer surgery in patients on prolonged ATT can be safely conducted with no increase in the incidence of hemorrhagic or thrombotic complications. The efficacy and safety of VTE pharmacoprophylaxis in laparoscopic colorectal surgery is still at issue. It is necessary to establish available protocols or guidelines by validating reliable studies.

Management of Patients Receiving Antiplatelet Therapy During Gastroenterological Surgery

“…A recent cohort research of 3072 patients receiving major digestive surgery showed that continuing aspirin monotherapy before surgery substantially decreased the risk of thromboembolism in those undergoing APT 4 . Nevertheless, most studies assessing perioperative APT management are patient registries or retrospective sub-analyses, 5–8 and clinical practice varies greatly as regards perioperative antithrombotic regimens 9–13 . This study showed that in patients receiving antiplatelet medication, continued preoperative aspirin therapy substantially lowers the likelihood of thromboembolic consequences.…”

“…4 Nevertheless, most studies assessing perioperative APT management are patient registries or retrospective sub-analyses, [5][6][7][8] and clinical practice varies greatly as regards perioperative antithrombotic regimens. [9][10][11][12][13] This study showed that in patients receiving antiplatelet medication, continued preoperative aspirin therapy substantially lowers the likelihood of thromboembolic consequences. Hence, preoperative continuation of single aspirin therapy is one of the best strategies to avoid major thromboembolic complications after elective gastroenterological surgery in patients undergoing APT.…”

“…Fujikawa et al 4 reported in a recent retrospective study of over 3000 patients undergoing major gastroenterological surgery that continued preoperative aspirin medication substantially reduced the incidence of thromboembolic events in APT-received patients. However, the majority of clinical research on perioperative APT treatment are retrospective sub-analyses, [5][6][7][8] resulting in a wide variety of antithrombotic management regimens in clinical settings [9][10][11][12][13] and management guidelines with unconvincing and inconsistent practice suggestions. 14,15 We designed this multicenter prospective study on the safety and feasibility of Gastroenterological Surgery in patients undergoing Antithrombotic Therapy (the GSATT study) to evaluate a consistent perioperative management plan for patients using antithrombotic medication.…”

“…Fujikawa et al 4 reported in a recent retrospective study of over 3000 patients undergoing major gastroenterological surgery that continued preoperative aspirin medication substantially reduced the incidence of thromboembolic events in APT-received patients. However, the majority of clinical research on perioperative APT treatment are retrospective sub-analyses, 5–8 resulting in a wide variety of antithrombotic management regimens in clinical settings 9–13 and management guidelines with unconvincing and inconsistent practice suggestions 14,15 …”