Application of venous thromboembolism prophylaxis program in patients with colorectal cancer using the enhanced recovery after surgery protocol |
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| Affiliation: | 1. Division of Colorectal Surgery, Department of Surgery, Seoul St. Mary''s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea;2. Division of Vascular and Transplant Surgery, Department of Surgery, Seoul St. Mary''s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea;1. Department of Surgery, Queen Elizabeth Hospital Birmingham, University Hospital Birmingham NHS Trust, Birmingham, United Kingdom;2. Department of HPB and Transplant Surgery, The Freeman Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK;3. Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom;4. Department of Hepatobiliary and Transplant Surgery, Queen Elizabeth Hospital Birmingham, University Hospital Birmingham NHS Trust, Birmingham, United Kingdom;5. Department of Clinical Oncology, Northern Centre for Cancer Care, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK;6. Department of General Surgery, University of Illinois Hospital and Health Sciences System, Chicago, IL, USA;7. Edward-Elmhurst Health, Department of Surgical Oncology, Naperville, IL, USA;8. Newcastle University, Newcastle Upon Tyne, Newcastle, United Kingdom;9. Department of Surgery, Southampton University Hospital NHS Foundation Trust, Southampton, UK;10. Department of Surgery, Fondazione Poliambulanza – Istituto Ospedaliero, Brescia, Italy;12. Esq, USA;1. Department of Pathology and Laboratory Medicine, University of California, Los Angeles, USA;2. Department of Surgery, University of California, Los Angeles, USA;3. Department of Biomathematics, University of California, Los Angeles, USA;4. John Wayne Cancer Institute at Saint John''s Health Center, Santa Monica, CA, USA;5. Melanoma Institute Australia, Sydney, Australia;6. The University of Sydney, Sydney, Australia;7. The Angeles Clinic and Research Institute, Los Angeles, USA;8. Cedars Sinai Medical Center, Los Angeles, CA, USA;9. Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and NSW Health Pathology, Sydney, Australia;10. Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA;11. Binder Institute of Pathology, Affiliated Pathologists Medical Group, Hermosa Beach, CA, USA;1. Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore;2. Ministry of Health Holdings, Singapore;3. Liver Transplant Service, Singhealth Duke-National University of Singapore Transplant Center, Singapore;4. Duke-National University of Singapore Medical School, Singapore;1. Departments of Surgical Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA, 19111, USA;2. Departments of Biostatistics, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA, 19111, USA |
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| Abstract: | IntroductionThe incidence of postoperative symptomatic venous thromboembolism (VTE) in western colorectal cancer is 1.1–2.5%. Anticoagulation and mechanical devices are recommended for moderate-to high-risk patients. Hospital stay and immobilization, as risk factors for VTE, are reduced by enhanced recovery after surgery (ERAS). This study aimed to evaluate short- and long-term outcomes for a VTE prophylaxis program after minimally invasive colorectal cancer surgery with ERAS protocol. In addition, predicting factors associated with VTE were investigated.Materials and methodsWe included 1043 patients diagnosed with colorectal cancer who required surgical treatment between January 2017 and December 2019 at a single institution. The patients enrolled followed the VTE prophylaxis program.ResultsFive (0.5%) patients developed symptomatic VTE, and the median follow-up period was 21 months. The Caprini score for all VTE patients was ≤8 points; thus, only mechanical prophylaxis was applied. The incidence rate of postoperative symptomatic VTE was only 0.5%. There was no association between variables considered as associated with VTE onset, such as age, perioperative complication, and length of postoperative day. TNM staging (OR 2.44, 95% CI 1.4–4.16, p = 0.001) and the Caprini score (OR 1.75, 95% CI 1.1–2.8, p = 0.001) were associated with VTE onset.ConclusionAlthough pharmacological prophylaxis was only performed for Caprini scores ≥9, the VTE incidence rate of patients with colorectal cancer undergoing VTE prophylaxis program was 0.6%; 0.7% is the incidence criterion of the moderate group recommended for pharmacological prophylaxis. Continuous follow-up is required for patients with advanced-stage colorectal cancer with high-risk Caprini scores. |
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| Keywords: | Enhanced recovery after surgery (ERAS) Venous thromboembolism (VTE) |
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