Venous thromboembolism after esophagectomy for cancer: a systematic review of the literature to evaluate incidence, risk factors, and prophylaxis

Theochari, Nikoletta A; Theochari, Christina A.; Kokkinidis, Damianos G.; Kechagias, Aristotelis; Lyros, Orestis; Giannopoulos, Stefanos; Mantziari, Styliani; Schizas, Dimitrios

doi:10.1007/s00595-021-02260-2

Cited by 7 publications

(10 citation statements)

References 40 publications

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“…Malignancy is also a well-known risk factor for VTE however and interestingly a recent large series of patients noted a prevalence of preoperative DVT in the lung cancer population of 9.6% (46). A systematic review in esophagectomy patients identified age, higher American Society of Anesthesiologists (ASA) class, history of cardiopulmonary disease and neoadjuvant chemoradiotherapy as risk factors for postoperative VTE (47).…”

Section: Prevention Of Venous Thromboembolism (Vte)mentioning

confidence: 99%

Prehabilitation and enhanced recovery after thoracic surgery: a narrative review

Al-Abri¹,

Shafiepour²

2023

Curr Chall Thorac Surg

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Background and Objective: Over the past two decades enhanced recovery after surgery (ERAS) pathways, which were established initially in colorectal surgery, have evolved and been adapted for other surgical disciplines. Goals include minimizing complications, optimizing recovery and an efficient return to preoperative baseline functioning. The introduction of ERAS pathways has led to both clinical benefits as well as cost savings. As these pathways consist of bundles of interventions throughout the perioperative period, the relative contribution of each individual component of these programs remains to be elucidated.The following narrative review article explores the application of ERAS principles to the thoracic surgery population. The evidence for individual components of these pathways will be discussed. Additionally, the introduction of prehabilitation interventions to the care of these patients will be explored. A brief case example is provided to illustrate how such interventions can aid in perioperative decision making.Methods: Medical computerized databases (PubMed and Cochrane Library) were searched for relevant reviews and guidelines published in English up to March 31, 2021, and hand searches of the references were performed. Articles were reviewed but no formal statistical analysis was undertaken.Key Content and Findings: Preoperative, intraoperative and postoperative elements of ERAS pathways were examined. Some elements, such as smoking cessation, have fairly robust evidence of benefit, but questions still remain regarding optimal duration of intervention especially when weighed against surgical delay. Others, for example preoperative carbohydrate loading, may lack significant evidence of improved outcomes but have been adopted widely because of ow perceived risk of harm. Formal prehabilitation programs show promise, particularly in the lung resection population.Conclusions: Implementation of ERAS pathways has benefited thoracic surgical patients, however there is varying strength with regards to the evidence for individual components. There is an ongoing need to better define the roles of individual elements of these pathways and to further advance knowledge regarding the optimal ways in which to apply some of them.

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Section: Prevention Of Venous Thromboembolism (Vte)mentioning

confidence: 99%

Prehabilitation and enhanced recovery after thoracic surgery: a narrative review

Al-Abri¹,

Shafiepour²

2023

Curr Chall Thorac Surg

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“…The only de nitive treatment is extensive surgery with preoperative chemotherapy, sometimes combined with radiotherapy (2). However, surgery increases the risk of thrombosis, and it is therefore imperative to offer cancer patients undergoing surgery optimal thromboprophylaxis, without compromising safety, to improve survival (3).…”

Section: Introductionmentioning

confidence: 99%

“…In 2022, the rst systematic review on purely oesophageal cancer estimated the VTE risk to be approximately 4% (3). However, both reviews could only identify 14 relatively heterogenous studies (3,18). This relatively small sample size, combined with great variation in received thromboprophylactic regimens makes it di cult to precisely estimate the incidence of VTE.…”

Section: Introductionmentioning

confidence: 99%

Thromboprophylaxis in Oesophageal Cancer Patients – A Study Protocol for a Randomized, Controlled Trial (TOP-RCT)

Gyldenholm,

Madsen,

Katballe

et al. 2024

Preprint

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Background The purpose of the study is to examine if prolonged thromboprophylaxis decreases the risk of thrombosis after intended curative surgery for oesophageal cancer. Study results are expected to inform a guideline for thromboprophylaxis after oesophageal cancer surgery. The perspective is to reduce morbidity and mortality in this critically ill patient group. Thrombosis is the second-most common cause of cancer death after the cancer itself. The risk of thrombosis depends on the cancer type, and upper gastrointestinal cancers are considered high risk. This risk is further increased when patients undergo surgery. However, only few studies have investigated the peri- and postoperative coagulation profile in oesophageal cancer patients. Due to this lack of knowledge, prophylaxis is currently restricted to ten days of 5000 IU (International Units) low-molecular weight heparin daily after surgery, whereas patients with gastric cancer receive 30 days of treatment. The present study examines whether a 30-day treatment is superior and safe, compared with the current ten-day treatment. Methods The study is a randomized controlled trial. Inclusion is ongoing, and we aim to include 100 patients. Blood samples are drawn before and after surgery, and the coagulation is extensively examined. The primary endpoint is the difference in plasma levels of prothrombin fragment 1+2 (F1+2) 30 days after surgery between the intervention and the standard group. Furthermore, patients are examined with ultrasound to screen for asymptomatic venous thrombotic events (VTE). Secondary endpoints are incidence of bleeding, symptomatic and asymptomatic VTE and mortality 30 days and one year after surgery. Discussion The study will provide valuable information on the perioperative coagulation profile and VTE risk of oesophageal cancer patients. The study seeks to aid in optimising the postoperative thromboprophylaxis, and the perspective is to reduce morbidity and mortality in this at-risk patient population. Trials registration The trial was prospectively registered at the EU Clinical Trials Register with ID 2021-001335-24 on 30.06.2021 and at ClinicalTrials.gov with study identifier NCT05067153.

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“…The 30-day postoperative VTE incidence was 4.5% and 2.3%, after esophagectomy and gastrectomy, respectively, which compares favorably with the NESQIP data reported by De Martino et al (7.3% and 2.7%, respectively) and from a recent review by Theochari et al (4% after esophagectomy). 4 , 5 …”

mentioning

confidence: 99%

“…Final details that could be further investigated are the types of recommended anticoagulation as well as the implementation of scoring systems based on patient characteristics and biomarkers to predict risk. 5 , 7 …”

mentioning

confidence: 99%

The Prevention of Venous Thromboembolism After Esophago-Gastric Surgery: A Never-Ending Story

Rocco

Reisenauer

2022

Ann Surg Oncol

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Venous thromboembolism after esophagectomy for cancer: a systematic review of the literature to evaluate incidence, risk factors, and prophylaxis

Cited by 7 publications

References 40 publications

Prehabilitation and enhanced recovery after thoracic surgery: a narrative review

Prehabilitation and enhanced recovery after thoracic surgery: a narrative review

Thromboprophylaxis in Oesophageal Cancer Patients – A Study Protocol for a Randomized, Controlled Trial (TOP-RCT)

The Prevention of Venous Thromboembolism After Esophago-Gastric Surgery: A Never-Ending Story

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