Is laparoscopic colorectal surgery with continuation of antiplatelet therapy safe without increasing bleeding complications?

Taguchi, Kazuhiro; Shimomura, Manabu; Egi, Hiroyuki; Hattori, Minoru; Mukai, Shoichiro; Kochi, Mitsugu; Sada, Haruki; Sumi, Yusuke; Nakashima, Ikki; Akabane, Shintaro; Sato, Koki; Ohdan, Hideki

doi:10.1007/s00595-019-01839-0

Cited by 7 publications

(7 citation statements)

References 23 publications

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“…Even though these procedures were in the same intermediate risk group, they could not be said to have the same bleeding risk. In addition, other previous studies on whether or not APT should be continued have often used preoperative APT‐free patients as a control group for the APT continuation group 20,21 . This was thought to be due to the limited number of patients who received APT.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the continuation and discontinuation of perioperative antiplatelet therapy in laparoscopic surgery for colorectal cancer: A retrospective, multicenter, observational study (YCOG 1603)

Ohya

Watanabe

Suwa

et al. 2020

Annals of Gastroent Surgery

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Aim The present study aimed to examine the effect of continuing antiplatelet therapy in the perioperative period for patients undergoing laparoscopic resection for colorectal cancer who had received preoperative antiplatelet therapy. Methods This retrospective, multicenter, observational study included patients who underwent laparoscopic surgery for colorectal cancer between January 2011 and May 2020. The study population was limited to patients who used antiplatelet therapy preoperatively. Results A total of 214 colorectal cancer patients who received antiplatelet therapy preoperatively were included in the present study. Eighty‐nine patients underwent surgery under the continuation of antiplatelet therapy, and 125 patients underwent surgery under the discontinuation of antiplatelet therapy before surgery. There were no significant differences between the two groups with regard to intraoperative blood loss (P = .889), intraoperative blood transfusion (P = 1.000), and conversion to laparotomy (P = 1.000). There were no significant differences between the two groups in the incidence of postoperative hemorrhagic complications (Clavien‐Dindo Grade ≥II, P = .453; Grade ≥III, P = .572) or three‐point major adverse cardiovascular events (P = .268). However, there were two cases of postoperative non‐fatal stroke in the discontinued antiplatelet therapy group. Conclusions The present study revealed that there were no significant differences in the surgical outcomes and postoperative complications between colorectal cancer patients who underwent laparoscopic resection with the continuation of antiplatelet therapy in the perioperative period and those in whom antiplatelet therapy was discontinued during the perioperative period. From the viewpoint of cardiovascular and cerebrovascular risk, it may be better for patients undergoing laparoscopic surgery for colorectal cancer to continue antiplatelet therapy. This study was registered with the Japanese Clinical Trials Registry as UMIN000038707 (http://www.umin.ac.jp/ctr/index.htm).

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Section: Discussionmentioning

confidence: 99%

Comparison of the continuation and discontinuation of perioperative antiplatelet therapy in laparoscopic surgery for colorectal cancer: A retrospective, multicenter, observational study (YCOG 1603)

Ohya

Watanabe

Suwa

et al. 2020

Annals of Gastroent Surgery

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“…15 When we compared cases with and without anti-thrombotic agents, the incidence of major haemorrhagic complications was significantly higher in the AT group than in the non-AT group despite sufficiently long period of medication discontinuation. Based on the literature, the haemorrhagic complications did not increase after abdominal surgery without withdrawal of aspirin, [15][16][17][18] whereas it could increase after the procedure with heparin bridge. 28,29 In the current study, the assessment by haemorrhagic site showed that the rate of severe haemorrhage from surgical site (anastomosis and peritoneal cavity) was similar in both groups.…”

Section: Ta B L E 5 Comparison Of Patient Characteristics Between Non...mentioning

confidence: 97%

“…Postoperative bleeding after laparoscopic colon resection occurred in approximately 1.1% of cases in a Japanese randomized trial that compared the outcomes of laparoscopic colectomy and laparotomy in colon cancer 15 . Some investigators have reported that the administration of aspirin without cessation during the perioperative period does not increase the haemorrhagic events during and after laparoscopic colorectal surgery 16–18 . However, the risks of thrombotic events after laparoscopic colorectal surgery remain unclear.…”

Section: Introductionmentioning

confidence: 99%

“… 15 Some investigators have reported that the administration of aspirin without cessation during the perioperative period does not increase the haemorrhagic events during and after laparoscopic colorectal surgery. 16 , 17 , 18 However, the risks of thrombotic events after laparoscopic colorectal surgery remain unclear. We, therefore, aimed to determine the incidence of cardiac and cerebral infarctions after laparoscopic colorectal resection.…”

Section: Introductionmentioning

confidence: 99%

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The incidence of cardiovascular thrombotic complications after laparoscopic resection in colorectal cancer in Japanese hospitals: A large‐scale clinical study

Ichikawa

Homma

Funakoshi

et al. 2021

Annals of Gastroent Surgery

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Aim The aim of this retrospective study was to investigate the incidence of cardiovascular thrombotic complications after laparoscopic resection in colorectal cancer. Methods This study involved 2017 patients with stages 0‐III colorectal cancer who underwent laparoscopic surgery at 17 Japanese hospitals between January 2010 and December 2013. We assessed the incidence of postoperative cardiovascular thrombotic and haemorrhagic complications. Results Laparoscopic surgeries were performed in 1152 men and 865 women with 1405 colon and 612 rectal cancers, respectively. Overall, 3%, 38%, 17%, 8%, and 9% of patients had comorbidities of heart failure, high blood pressure, diabetes, history of stroke, and vascular disease, respectively. Antithrombotic agents were being consumed by 17% of patients. The types (and perioperative rest periods) of the antithrombotic agents were aspirin in 58% (18.6 days), clopidogrel in 19% (21.1 days), cilostazol in 13% (13.3 days), and warfarin potassium in 21% (14.6 days) of cases with antithrombotic agents. Surgical time and blood loss in the total cohort were 234 minutes and 56 mL. Four cases (0.2%) had cardiovascular thrombotic complications, including one severe cardiac infarction and one stroke with major sequelae (CHADS2 scores were 2 points in both cases). Hemorrhagic complications occurred in 19 cases (0.9%). In particular, the incidence of the major gastroduodenal haemorrhagic ulcer was higher in cases with antithrombotic agents than without them (0.05% vs 0%, P = .02). Conclusion The incidence of cardiovascular thrombotic complications was rare, although severe cardiac infarction and stroke could occur even after minimally invasive surgery in colorectal cancer.

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“…Ten were observational cohort studies, all of which were retrospective in nature. Concerning the research on the management of patients with prolonged ATT, one study was a multicenter retrospective cohort analysis [ 8 ] and three were analyses using the propensity score matching method [ 6 , 9 , 11 ].…”

Section: Reviewmentioning

confidence: 99%

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

Fujikawa¹,

Takahashi²

2022

Cureus

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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.

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Is laparoscopic colorectal surgery with continuation of antiplatelet therapy safe without increasing bleeding complications?

Cited by 7 publications

References 23 publications

Comparison of the continuation and discontinuation of perioperative antiplatelet therapy in laparoscopic surgery for colorectal cancer: A retrospective, multicenter, observational study (YCOG 1603)

Comparison of the continuation and discontinuation of perioperative antiplatelet therapy in laparoscopic surgery for colorectal cancer: A retrospective, multicenter, observational study (YCOG 1603)

The incidence of cardiovascular thrombotic complications after laparoscopic resection in colorectal cancer in Japanese hospitals: A large‐scale clinical study

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

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