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Observational Study
. 2024 Mar 1;110(3):1519-1526.
doi: 10.1097/JS9.0000000000000986.

From early risk to 1-year mortality: a comprehensive assessment of postoperative venous thromboembolism in upper gastrointestinal cancer patients - a nationwide cohort study

Jérémie Thereaux  1   2 , Bogdan Badic  3   2 , Basile Fuchs  4 , Cyril Leven  1   5 , Anais Caillard  6 , Karin Lacut  1   7 , Jean-Philippe Metges  8 , Francis Couturaud  1   7
Affiliations
Observational Study

From early risk to 1-year mortality: a comprehensive assessment of postoperative venous thromboembolism in upper gastrointestinal cancer patients - a nationwide cohort study

Jérémie Thereaux et al. Int J Surg. .

Abstract

Background: Venous thromboembolism (VTE) is a well-recognized complication following gastrointestinal cancer surgery, particularly early postoperatively. The incidence and risk factors of VTE within 1-year after esophageal (including esophago-gastric junction) (ECS) and gastric (GCS) cancer surgeries, and especially its impact on 1-year global mortality, are yet under-explored.

Methods: This nationwide observational population-based cohort study used data extracted from all patients undergoing ECS and GCS in France between 1 January 2015 and 31 December 2017. Multivariate logistic regression was used to identify risk factors for 90 postoperative days (POD) VTE (OR 95% CI). Cox proportional hazards models investigated the impact of 1-year postoperative VTE on 1-year global mortality [HR (95% CI)].

Results: During the study period, 8005 patients underwent ECS ( N =3429) or GCS ( N =4576) (31.8% female; 66.7±12.1 years old). Majority ( N =4951) of patients had preoperative treatment (chemotherapy or radiochemotherapy). Ninety POD incidence of VTE were 4.7% (ECS=6.2%) (GCS=3.6%) (44.7% during first hospitalization, 19.0% needing readmission, and 36.3% ambulatory management). Main risk factors were three and two field esophagectomy [3.6 (2.20-5.83) and 2.2 (1.68-3.0)], obesity [1.9 (1.40-2.58)] and history of VTE [5.1 (2.72-9.45)]. Late-onset VTE rates (occurring between the 6th and 12th month) represented 1.80 and 1.46% of the overall ECS and GCS groups. Patients with VTE within 1-year had higher risks of 1-year global mortality: (2.04 1.52; 2.73) and 2.71 (2.09; 3.51), respectively.

Conclusion: Our extensive analysis of a nationwide database highlights the significant risk of postoperative VTE after ECS and GCS, persisting within 90 POD and up to 1-year. Crucially, a higher risk of global mortality within 1-year for patients experiencing early or late VTE was found. These findings could advocate for further research into extended prophylactic regimens, particularly for those most at risk.

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Conflict of interest statement

All authors have completed the disclosure form.

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Figures

Figure 1
Figure 1
Forest plots showing the adjusted odds-ratio (OR) of 90 POD VTE in patients undergoing ECS and GCS. VTE, venous thromboembolism.
Figure 2
Figure 2
One year postoperative survival probabilities without VTE for patients undergoing ECS or GCS. Patients dying from another cause were censored. ECS, esophageal (including oesophagogatsric junction) cancer surgery; GCS, gastric cancer surgery; VTE, venous thromboembolism.
See this image and copyright information in PMC

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