Patients undergoing cancer resections for abdominal and pelvic malignancies are thought to be at increased risk of developing postoperative venous thromboembolism (VTE) up to 12 weeks post-surgery. The use of extended VTE prophylaxis (EVP) is well documented for high-risk orthopaedic surgery, and guidelines are increasingly supporting its use in certain abdominal cancers. We aimed to explore the role of EVP in oesophagogastric cancer resections.
A systematic review (using MEDLINE, EMBASE, PubMed, following a PRISMA protocol) assessing the use of or benefits of EVP post-oesophagogastric cancer resection surgery was performed.
Following this, a retrospective analysis of a prospectively maintained single-centre cancer database was performed looking at outcomes of patients who underwent oesophagogastric cancer resections between January 2015 and August 2020. Patients were assessed for incidence of VTE in the pre, peri and post-operative periods.
Seven studies, including four randomised controlled trials, were identified that assessed the use of EVP post abdominal surgery. None specifically analysed the use of EVP post oesophagogastric surgery.
In our local database analysis, a total of 144 patients underwent oesophagogastric cancer surgery of which seven experienced asymptomatic VTE (5%); five pulmonary emboli (PE) and two deep vein thrombosis (DVT). Of these, three occurred pre-operatively (43%), three perioperatively (43%) and one in the extended postoperative period (14%).
Within the VTE group, three had received EVP (43%), of which two experience PE.
While there is evidence supporting EVP in abdominal surgeries, there is a paucity of research specifically investigating its use in upper gastrointestinal surgery in the prevention of VTE. The rates of VTE in our retrospective analysis were higher than previously cited, especially of pulmonary emboli (4%). The incidence of VTE in the post-operative period may support the use of EVP, however, prospective research is needed to better understand its role in oesophagogastric cancer resections.