Venous thromboembolism in patients receiving perioperative chemotherapy for esophagogastric cancer

Abstract

The association between venous thromboembolism and chemotherapy for esophagogastric cancer is well known in patients treated with palliative intent. Whether this risk extends to the neoadjuvant and perioperative setting is unclear. A retrospective interrogation of databases of patients receiving perioperative chemotherapy for potentially curative intent at the Leicester (2006-2011) and Nottingham (2004-2011) esophagogastric cancer centers was performed. Thromboembolic events were diagnosed in 48 of 384 patients (12.5%), 21 (5.5%) at presentation, 12 (3%) during neoadjuvant chemotherapy, and 15 (3.9%) in the postoperative period. There were no deaths from thromboembolic disease. By site these comprised catheter-related axillary vein thrombosis in 7 patients, deep venous thrombosis in 12 patients, and pulmonary embolism in 29 patients. Twenty-five of the 29 pulmonary emboli were incidental findings on staging computed tomography imaging. Combination chemotherapy with epirubicin, cisplatin, and capecitabine appeared to carry the greatest risk for the development of thromboembolism. Seven of the 12 patients (58%) who developed thromboembolism during neoadjuvant chemotherapy did not proceed to surgery because of deterioration in performance status. Preoperative thromboembolic disease resulted in a significant increase in the interval between chemotherapy and surgery, but did not influence either length of hospital stay or survival. Venous thromboembolism will develop in 12.5% of patients treated with potentially curative intent. This adverse event can occur at any time during the patient journey. In contrast to the commonly held view, this did not translate into a poorer prognosis.

Predictive factors of thromboembolic complications in patients with esophagogatric adenocarcinoma undergoing preoperative chemotherapy

“…In contrast to previous reports, the present study did not show any association between vTEEs and disease outcome or mortality [24,25]. Consistent with our findings are the results from other studies in patients with esophagogastric cancer undergoing preoperative treatment [13,18,20]. Similarly, Starling et al demonstrated, in their large REAL-2 population, that vTEEs were not associated with adverse prognosis, as opposed to arTEEs which had detrimental effect [11], and this is in accordance with our observations.…”

“…Importantly, there is no consensus on the potential use of thromboprophylaxis in patients undergoing neoadjuvant chemotherapy [21,22]. In the present cohort, Khorana score was not useful in predicting vTEEs, while Khanna et al [20] administered LMWH only in patients with a history of TEEs or thrombophilias and reported a relatively low incidence of vTEEs of 3% during neoadjuvant chemotherapy. We could also detect a potentially protective effect of anticoagulant treatment regarding the risk of vTEEs.…”

“…We demonstrated that a primary tumor site in the stomach, a BMI !25.0 kg/m 2 and the placement of CVAD were independent risk factors for the development of vTEEs. The higher incidence of vTEEs in patients with gastric primaries and CVAD was also confirmed by other investigators [13,[18][19][20]. However, Starling et al did not demonstrate a significant difference in the rate of TEEs in REAL-2 patients with gastric tumors (11.2%), compared to those with GEJ (13.7%) or esophageal cancers (9.9%) [11].…”

Primary prevention and treatment of venous thromboembolic events in patients with gastrointestinal cancers - Review

“…Among the different subtypes of malignancy, some gastrointestinal cancers have a clinically relevant VTE incidence of more than 5% in the first year after cancer diagnosis (Figure 1), such as pancreatic (16%-22%), gastric (12%-17%) and colorectal (8%-12%) cancers [2,[5][6][7][8] . Symptomatic VTE is not only associated with substantial morbidity and complications in clinical management, but has been shown to have a detrimental effect on cancer survival [9][10][11] . Acute and follow-up complications such as intestinal necrosis and esophageal bleeding due to portal hypertension may be life threatening if intra-abdominal veins are involved [12][13][14][15] .…”

Pulmonary Embolism: Some Issues of Epidemiology and Treatment in Cancer Patients

“…Частота развития ТЭЛА у больных с раком прямой кишки, которым проводится химиотерапия, составляет от 1 до 4% [6], в 17% случаев ТЭЛА выступает причиной послеоперационной летальности таких пациентов [7]. При гастроэзофагеальном раке ТЭЛА наблюдается в 7,6% случаев [8], после гастрэктомии -в 0,2% [9]. По данным зарубежных исследователей, риск возникновения ТЭЛА у больных с диагнозом аденокарциномы желудка очень высок и составляет 25%, при этом смертность от ТЭЛА может достигать 18% [10].…”