Thromboembolic and bleeding complications in patients with oesophageal cancer

Abstract

Background In patients who undergo curative treatment for oesophageal cancer, risk estimates of venous thromboembolism (VTE), arterial thromboembolism and bleeding are needed to guide decisions about thromboprophylaxis. Methods This was a single‐centre, retrospective cohort study of patients with stage I–III oesophageal cancer who received neoadjuvant chemoradiation followed by oesophagectomy. The outcomes VTE, arterial thromboembolism, major bleeding, clinically relevant non‐major bleeding and mortality were analysed for four consecutive cancer treatment stages (from diagnosis to neoadjuvant chemoradiotherapy, during neoadjuvant treatment, 30‐day postoperative period, and up to 6 months after postoperative period). Results Some 511 patients were included. The 2‐year survival rate was 67·3 (95 per cent c.i. 63·2 to 71·7) per cent. During the 2‐year follow‐up, 50 patients (9·8 per cent) developed VTE, 20 (3·9 per cent) arterial thromboembolism, 21 (4·1 per cent) major bleeding and 30 (5·9 per cent) clinically relevant non‐major bleeding. The risk of these events was substantial at all treatment stages. Despite 30‐day postoperative thromboprophylaxis, 17 patients (3·3 per cent) developed VTE after surgery. Patients with VTE had worse survival (time‐varying hazard ratio 1·81, 95 per cent c.i. 1·25 to 2·64). Most bleeding events occurred around the time of medical intervention, and approximately one‐half during concomitant use of prophylactic or therapeutic anticoagulation. Conclusion Patients with oesophageal cancer undergoing neoadjuvant chemoradiotherapy and surgery are at substantial risk of thromboembolic and bleeding events throughout all stages of treatment. Survival is worse in patients with thromboembolic events during follow‐up.

A prospective multicenter study to evaluate the impact of cryotherapy on dysphagia and quality of life in patients with inoperable esophageal cancer

“…There were no procedure-related perforations, which is likely to reflect the extensive physician experience with cryotherapy in these centers. Although published data on the risk of bleeding in esophageal cancer are scarce, the data available suggest a 5 % risk of major bleeding and 3 % risk of GI bleeding, which is consistent with the risk of bleeding seen in the current study 26 . It is our practice and recommendation that all patients with esophageal cancer undergoing cryotherapy be placed on twice-daily proton pump inhibitors.…”

“…▶ Table 3 shows univariable analysis for change in QoL and dysphagia scores across the different categories of predictor variables for a total of 175 cryotherapy treatments. Only tumor ▶ Freeze time, median (range), seconds/cycle 20 (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30) stage was significantly (statistically but not clinically) associated with an improvement in QoL. None of the evaluated factors were associated with an improvement in dysphagia.…”