Postoperative venous thromboembolism in gynecologic oncology patients undergoing minimally invasive surgery: does modality matter?

Abstract

<h3>Objectives:</h3> Minimally invasive surgery (MIS) is increasingly utilized for gynecologic cancers. While rates of venous thromboembolism (VTE) after MIS are low overall, risk factors such as malignancy and prior pelvic surgery may increase risk of perioperative VTE. Various guidelines exist regarding extended chemoprophylaxis with low molecular weight heparin (LMWH) for VTE prevention. Our objective was to determine incidence of 30-day postoperative VTE in patients undergoing MIS for gynecologic malignancies and to determine differences in the incidence of VTE by MIS modality. <h3>Methods:</h3> We collected demographic and perioperative variables for all patients undergoing MIS (robot-assisted, multi-port laparoscopy, single-port laparoscopy) for gynecologic cancers between January 2014 and December 2018. Patients <18 years, with benign pathology, or on preoperative anticoagulation were excluded. Logistic regression, Chi-square, Fisher's exact test, and one-way ANOVA were performed to determine risk factors related to VTE occurrence. <h3>Results:</h3> We identified 818 patients who underwent MIS (median age 61, 97% non-Hispanic White, mean BMI 34 kg/m²). Most had Stage I disease (81.4%) and uterine cancer (81.6%). 99.9% received intraoperative unfractionated heparin (UFH) and 96.6% received immediate postoperative UFH. Three VTE events occurred within 30 days following surgery (0.3%). Twelve patients received extended chemoprophylaxis with LMWH (1.5%); 11 patients received a 28-day course while one patient received a 14-day course. VTE was diagnosed in a total of 17 patients within 18 months of surgery (2%, median time to VTE 12 months). Of those diagnosed with VTE, 11 patients underwent robot-assisted laparoscopy, 4 patients underwent multi-port laparoscopy and 2 patients underwent single-port laparoscopy. Incidence of VTE did not differ between MIS modalities (<i>p</i>=0.6). Patients with Stage III disease (<i>p</i><0.001) and longer operative time (<i>p</i>=0.04) were more likely to experience postoperative VTE. Age, smoking status, BMI, and cancer type were not significant risk factors for postoperative VTE. <h3>Conclusions:</h3> The incidence of postoperative VTE in patients with gynecologic cancers undergoing MIS is low and does not differ by modality. Extended chemoprophylaxis is unlikely to be beneficial in patients with gynecologic malignancies undergoing MIS procedures.