Ovarian vein thrombosis after debulking surgery for ovarian cancer: epidemiology and clinical significance

Abstract

OBJECTIVE Ovarian vein thrombosis is associated with pregnancy and pelvic surgery. Postpartum ovarian vein thrombosis is associated with infection and a high morbidity rate, and is treated with anticoagulant and intravenous antibiotic therapy. The natural history of such thrombotic events after debulking surgery for ovarian cancer has not been well described. Our objective was to characterize the presentation and outcomes for patients with this condition at our institution. STUDY DESIGN We conducted a retrospective study of patients who underwent surgical debulking for ovarian cancer at Memorial Sloan Kettering Cancer Center between the years 2001 and 2010. Patients were included if contrast computed tomography scans of the abdomen and pelvis were performed both within 12 weeks before and 12 weeks after the surgery. The images were reviewed to assess for the presence and extent of a new post-operative ovarian vein thrombosis. When available, subsequent studies were assessed for thrombus progression. Medical records were reviewed to determine if anticoagulation was used for treatment of the thrombotic episode and to record the occurrence of any new significant venous thromboembolic event in the following year. RESULTS 159 patients had satisfactory imaging. New ovarian vein thrombosis was a common complication of debulking surgery, as found in 41 (25.8%) of patients. Only 5 women with ovarian vein thrombosis were started on anticoagulation, of which 2 individuals had an independent venous thromboembolic event as indication for treatment. Only 2 (4.9%) of the ovarian vein thromboses progressed to the inferior vena cava or left renal vein on subsequent scan. The estimated cumulative incidence of venous thromboembolism one year after the first post-operative scan was 17.1% for patients in the new ovarian vein thrombosis group, versus 15.3% of individuals for the group without a post-operative ovarian vein thrombosis (p=0.78). CONCLUSION Ovarian vein thrombosis is commonly encountered after debulking surgery for ovarian cancer. Anticoagulation is usually not indicated and clinically meaningful thrombus progression rarely occurs.

Fibrosis of mesothelial cell-induced peritoneal implantation of ovarian cancer cells

“…Mesothelial cells are an important constituent of the peritoneal microenvironment. Injury to and changes in peritoneal mesothelial cells morphological structure make the peritoneum a favorable soil for ovarian cancer cells 9,10. We have confirmed the MFT process in peritoneal tissues of ovarian cancer patients with peritoneal metastasis and fibrotic mesothelial cell release of chemokines to promote dissemination.…”

PBOV1 correlates with progression of ovarian cancer and inhibits proliferation of ovarian cancer cells

“…Serum molecular tests such as cancer antigen (CA) 125 test are useful in differential diagnosis, but have not been demonstrated as effective methods for screening for early-stage ovarian cancer due to the unacceptable low sensitivity and specificity (5). It has been considered that numerous other genetic changes are involved in the development and progression of ovarian cancer (6,7). However, little is known concerning the exact molecular events leading to its development and progression.…”

Ovarian Vein Thrombosis: A Narrative Review

“…In the study by Assal et al, 17 women with isolated OVT received parenteral anticoagulation in the acute phase, with either low-molecular-weight heparin (LMWH; n ¼ 13) or unfractionated heparin (n ¼ 4), and the majority of them (64.7%) were subsequently switched to vitamin K antagonists (VKAs). 13 Conversely, in the study by Mantha et al, five women with cancer-associated OVT were treated with parenteral anticoagulation only, 14 in line with guidelines for the treatment of cancer-associated DVT or pulmonary embolism (PE). 60 In the study by Salomon et al, 12 women with postpartum OVT received enoxaparin at therapeutic dose (1 mg/kg twice daily) for 2 weeks, followed by half-dose (1 mg/kg daily) for 3 months.…”

“…14 One-year survival rate was also similar in the two groups (95.1 vs. 93.2%, p ¼ 0.84). 14 Rare complications of OVT include ovarian infarction with potential influence on fertility, 24 and obstruction of the right ureter which can lead to hydronephrosis and renal failure. 75,76 Septic pelvic thrombophlebitis can also evolve into septic shock or septic emboli, which have high mortality rate.…”

“…8,11,12 Pregnancy-related OVT is usually diagnosed in women in their early thirties, 8,13 while the other types of OVT involve older females with mean age ranging from 40 to 60 years in different studies. 5,8,13,14 Due to the anatomical difference in venous drainage, the right ovarian vein is more frequently involved (70-80% of cases); occasionally, the thrombosis can be bilateral (around 10% of cases). 7,9 Pathophysiology and Risk Factors…”