Abstract
BackgroundPatients with gynecologic cancer have a high risk of venous thromboembolism (VTE) like patients with other cancers. However, there is little information on risk factors for VTE during gynecologic surgery and no uniform preventive strategy. Our objectives were to identify risk factors for perioperative VTE in gynecologic patients and establish methods for prevention.MethodsWe analyzed 1,232 patients who underwent surgery at the Department of Obstetrics and Gynecology of St. Marianna University School of Medicine between January 2005 and June 2008. We investigated (1) risk factors for preoperative VTE, (2) use of an inferior vena cava (IVC) filter, and (3) risk factors for postoperative VTE.ResultsThere were 39 confirmed cases of perioperative VTE (3.17%), including 25 patients with preoperative VTE and 14 with postoperative VTE. Thirty-two patients had cancer and seven patients had benign diseases. Twenty-two of the 32 cancer patients (68.7%) had preoperative VTE, while postoperative VTE occurred in 10 cancer patients. Multivariate analysis indicated that ovarian cancer, tumor diameter ≥10 cm, and previous of VTE were independent risk factors for preoperative VTE. Among ovarian cancer patients, multivariate analysis showed that an age ≥50 years, the presence of heart disease, clear cell adenocarcinoma, and tumor diameter ≥20 cm were independent risk factors for preoperative VTE. The factors significantly related to preoperative VTE in patients with benign disease included previous VTE, age ≥55 years, tumor diameter ≥20 cm, and a history of allergic-immunologic disease. Thirteen of the 25 patients (52%) with preoperative VTE had an IVC filter inserted preoperatively. Postoperative screening (interview and D-dimer measurement) revealed VTE in 14/1,232 patients (1.14%). Multivariate analysis indicated that cancer surgery, a history of allergic-immunologic disease, and blood transfusion ≥2,000 ml were independent risk factors for postoperative VTE.ConclusionsPerioperative VTE is often fatal and preventive measures should be taken in the gynecologic field, especially when patients have the risk factors identified in this study. Since VTE is often present before surgery, preoperative screening is important and use of an IVC filter should be considered.
Highlights
Patients with gynecologic cancer have a high risk of venous thromboembolism (VTE) like patients with other cancers
When multivariate analysis was performed with the five variables shown in Table 2, there was a significant association between VTE and ovarian cancer, tumor diameter ≥10 cm, and a history of VTE, with the risk ratios being 20.521, 6.442, and 34.596, respectively
Their multivariate analysis showed that a body mass index (BMI) ≥30 kg/m2 and old age were independent risk factors for VTE in ovarian cancer patients
Summary
Patients with gynecologic cancer have a high risk of venous thromboembolism (VTE) like patients with other cancers. There is little information on risk factors for VTE during gynecologic surgery and no uniform preventive strategy. Our objectives were to identify risk factors for perioperative VTE in gynecologic patients and establish methods for prevention. A rapid increase of venous thromboembolism (VTE) has occurred in Japan with aging of the population, more complex operations, and new therapeutic procedures related to improvements of abdominal surgery and it is important to consider drug prophylaxis, especially in patients with multiple risk factors [1]. The above reports suggest that it is necessary to strengthen preventive measures for perioperative VTE in the field of gynecology, and it is important to identify the risk factors for this condition
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