Visceral Thromboses in Pancreas Adenocarcinoma: Systematic Review

Abstract

Within gastrointestinal malignancies, primary hepatocellular carcinoma and pancreatic ductal adenocarcinoma (PDAC) are frequently associated with visceral thromboses (VT). Thrombus formation in the portal (PVT), mesenteric (MVT), or splenic vein (SVT) system leads to portal hypertension and intestinal ischemia. VT in PDAC may convey a risk of increased distal thrombosis and poses therapeutic uncertainty regarding the role of anticoagulation. An increasing number of reports describe VT associated with PDAC. It is possible that early diagnosis of these events may help reduce morbidity and speculatively improve oncologic outcomes. To perform a systematic review to study PVT, MVT, and SVT associated with PDAC, and to provide a comprehensive review. Medline/PubMed, Embase, Web of Science, Scopus, and the Cochrane Library. Data Extraction and Assessment: Two blinded independent observers extracted and assessed the studies for diagnosis of PVT, MVT, and SVT in PDAC. Studies were restricted to English-language literature published between 2007 and 2016. Eleven articles were identified. Five case reports and 7 retrospective studies were found, with a total of 127 patients meeting the inclusion criteria. The mean age at diagnosis was 64 years. PVT was found in 35% (n = 46), SVT in 52% (n = 65), and MVT in 13% (n = 15). Mean follow-up time was 26 months. Only 3 of the selected articles studied the impact of anticoagulation in VT. All patients with nonvisceral thrombosis (eg, deep-vein thrombosis, pulmonary emboli) were therapeutically treated; in contrast, patients with VT only rarely received treatment. VT in PDAC is a frequent finding at diagnosis or during disease progression. Evidence to guide treatment choices is limited, and current management is based on inferred experience from nononcologic settings. Anticoagulation appears to be safe in VT, with most of the large studies recommending a careful assessment for patients at a high risk of bleeding.

Trends and In-Hospital Outcomes of Splanchnic Vein Thrombosis Associated with Gastrointestinal Malignancies: A Nationwide Analysis

“…Screening for PVT is required as part of the current Barcelona Clinic Liver Cancer staging system as the prognosis for patients with HCC and PVT is much worse [8]. Meanwhile, the higher increase in trend of hospitalization in pancreatic adenocarcinomas for SVT-related malignancies is compatible with recent data, as published by Hicks et al [16] and Afzal et al [17], suggesting that SVT is not only a finding of more advanced stages of the disease but is in itself a predictor of mortality leading to more frequent admissions. The high incidence of such occurrence is explained by the pro-thrombotic and pro-angiogenic state associated with both malignancies that are necessary for tumor growth and metastasis.…”

Inferior Vena Cava Tumor Thrombus Secondary to Mucinous Adenocarcinoma of the Stomach

“…Thrombosis in gastric cancer, while rarely seen (1.2%), is similar to HCC in that the portal vein is usually affected [ 1 ]. Pancreatic cancers, while commonly pro-thrombotic, are more frequently associated with splenic, portal, or mesenteric thrombi rather than IVC [ 5 ]. Thus, IVC thrombus from gastric cancer is extremely rare.…”

ONKOTEV Score as a Predictive Tool for Thromboembolic Events in Pancreatic Cancer—A Retrospective Analysis

“…With the advances of diagnostic imaging, VsT has become a well-defined entity that is commonly diagnosed in patients with pancreatic cancer [34]. VsT is undervalued when compared with PE or DVT, and, as a consequence, anticoagulation therapy, a safe therapeutic approach as long as bleeding risk is carefully assessed, is underutilized [34,35]. In our cohort VsT was asymptomatic in 21 of 26 patients and diagnosed by a CT scan, in the context of pancreatic cancer diagnosis, staging, or response evaluation.…”