OBJECTIVE
Ovarian vein thrombosis is associated with pregnancy and pelvic surgery. Postpartum ovarian vein thrombosis is associated with infection and a high morbidity rate, and is treated with anticoagulant and intravenous antibiotic therapy. The natural history of such thrombotic events after debulking surgery for ovarian cancer has not been well described. Our objective was to characterize the presentation and outcomes for patients with this condition at our institution.
STUDY DESIGN
We conducted a retrospective study of patients who underwent surgical debulking for ovarian cancer at Memorial Sloan Kettering Cancer Center between the years 2001 and 2010. Patients were included if contrast computed tomography scans of the abdomen and pelvis were performed both within 12 weeks before and 12 weeks after the surgery. The images were reviewed to assess for the presence and extent of a new post-operative ovarian vein thrombosis. When available, subsequent studies were assessed for thrombus progression. Medical records were reviewed to determine if anticoagulation was used for treatment of the thrombotic episode and to record the occurrence of any new significant venous thromboembolic event in the following year.
RESULTS
159 patients had satisfactory imaging. New ovarian vein thrombosis was a common complication of debulking surgery, as found in 41 (25.8%) of patients. Only 5 women with ovarian vein thrombosis were started on anticoagulation, of which 2 individuals had an independent venous thromboembolic event as indication for treatment. Only 2 (4.9%) of the ovarian vein thromboses progressed to the inferior vena cava or left renal vein on subsequent scan. The estimated cumulative incidence of venous thromboembolism one year after the first post-operative scan was 17.1% for patients in the new ovarian vein thrombosis group, versus 15.3% of individuals for the group without a post-operative ovarian vein thrombosis (p=0.78).
CONCLUSION
Ovarian vein thrombosis is commonly encountered after debulking surgery for ovarian cancer. Anticoagulation is usually not indicated and clinically meaningful thrombus progression rarely occurs.