Incidence, risk profile and morphological pattern of venous thromboembolism after prostate cancer surgery

Abstract

To cite this article: Beyer J, Wessela S, Hakenberg OW, Kuhlisch E, Halbritter K, Froehner M, Wirth MP, Schellong SM. Incidence, risk profile and morphological pattern of venous thromboembolism after prostate cancer surgery. J Thromb Haemost 2009; 7: 597-604.Summary. Background: Venous thromboembolism (VTE) is the most common non-surgical complication after major pelvic surgery. Little is known about the risk factors or the time of development of postoperative venous thrombosis. Methods: A cohort of 523 consecutive patients undergoing radical prostatectomy with lymphadenectomy was prospectively assessed by complete compression ultrasound at days )1, +8 and +21. Results: Complete data were available in 415 patients, while four patients had VTE before surgery and were excluded from the analysis. In the remaining 411 patients, 71 VTE events were found in 69 patients (16.8%). Most were limited to calf muscle veins (56.5%), followed by deep calf vein thrombosis (23.2%), proximal deep vein thrombosis (DVT, 14.5%) and pulmonary embolism (PE, 5.8%). Of the 14 patients with proximal DVT/PE, 11 patients (78.6%) developed VTE between days 8 and 21. Risk factors for VTE were a personal history of VTE (OR 3.0), pelvic lymphoceles (LCs) impairing venous flow (OR 2.8) and necessity of more than two units of red blood cells (OR 2.6). Conclusion: Venous thromboembolism is common after radical prostatectomy. A significant proportion develops after day 8, suggesting that prolonged heparin prophylaxis should be considered. Since LCs with venous flow reduction result in higher rates of VTE, hemodynamically relevant lymphoceles should be surgically treated.

Risk of thromboembolic disease in men with prostate cancer undergoing androgen deprivation therapy

“…Nonetheless, previous surgeries and disease progression are strongly associated with an increased risk of TED and should be accounted for when assessing the impact of ADT on TED [1][2][3][4][5][6][7][8][9][10]. In our previous study, we observed an increased risk of TED in men with PCa on ADT compared with the general Swedish male population, although a number of health and lifestyle factors could not be accounted for [2].…”

“…Surgery and disease severity are known to increase the risk of thromboembolic disease (TED) in men with prostate cancer (PCa) [1][2][3][4][5][6][7][8][9]. The risk of TED is further enhanced in men with PCa treated with androgen deprivation therapy (ADT) [1,2,10,11]; however, it is unknown to what extent ADT influences the risk of TED when accounting for previous surgeries and disease progression.…”

Venous thromboembolism (VTE) prophylaxis and urological pelvic cancer surgery: a UK national audit

“…Other evidence to support the NICE recommendations but not considered by NICE include work by Beyer et al [14] who published a study that investigated the incidence of VTE after RP. The authors reported that 16.8% of patients had a DVT after RP, of which 5.8% had a PE.…”

Venous thromboembolism prophylaxis in cancer patients — guidelines focus on surgical patients

“…Hammond et al analyzed 20,000 extensive oncological surgeries, including urological oncological surgery and found that symptomatic VTE occurred in 1.8% of patients after prostatectomy [201]. In cases, where no prophylaxis was applied and thromboembolic complications were assessed by the means of imaging methods after prostatectomy, the risk seems to be significantly higher (16.8-32%), which results from high percentage of asymptomatic deep venous thrombosis cases [203][204].…”