Prevalence of deep venous thrombosis detected by ultrasonography before surgery in patients with gastric cancer: a retrospective study of 1140 consecutive patients

Abstract

Background The prevalence of deep venous thrombosis (DVT) in patients with gastric cancer before surgery is unknown. This study aimed to clarify the risk factors for DVT of the lower extremities in patients with gastric cancer before surgery and to evaluate the usefulness of ultrasonographic screening for prevention of postoperative pulmonary thromboembolism (PTE). Methods Patients who had undergone lower-extremity venous ultrasonography before surgery for gastric cancer were retrospectively analyzed. Univariate and multivariate logistic regression analyses were performed to identify the predictors of DVT before surgery. Perioperative management of patients with DVTs and the incidence of postoperative PTE were investigated. Results Of the total 1140 patients, 86 had DVT preoperatively. On univariate analysis, the incidence of DVT was significantly higher with: female sex; age C80 years; PS C 1 (vs. PS = 0); stage IV (vs. stages I-III); history of preoperative chemotherapy; and the presence of a central venous catheter (CVC). Multivariate logistic regression analysis demonstrated that sex, age C80 years, PS C 1, history of preoperative chemotherapy, and the presence of CVC were significantly correlated with DVT before surgery. Postoperative PTE occurred in 2 patients with proximal DVT. No patients in whom DVT was not detected developed PTE. Conclusions Female sex, older age, worse PS, the presence of CVC, and a history of preoperative chemotherapy were the independent risk factors for DVT. Routine lower-extremity venous ultrasonographic screening is useful for prevention of PTE because it can identify patients at high or low risk for PTE.

Prospective implementation of a standardized screening protocol for deep venous thrombosis in abdominal surgical oncology patients

“…23 Receipt of systemic chemotherapy in the year prior to surgery was associated with occult DVT in univariate analysis only; the current analysis may have been underpowered to detect an independent association, as one has been reported previously. 11,16 There was no association between gender and rate of occult DVT, in contrast with previous studies suggesting a higher rate among women. [14][15][16] While patients with occult DVT tended to be older (median, 67 vs 60 years), this was not statistically significant but consistent with previous literature.…”

“…Consistent with previous literature, the rate of occult DVT among patients with prior history of VTE was substantial (47%) . Receipt of systemic chemotherapy in the year prior to surgery was associated with occult DVT in univariate analysis only; the current analysis may have been underpowered to detect an independent association, as one has been reported previously . There was no association between gender and rate of occult DVT, in contrast with previous studies suggesting a higher rate among women .…”

“…While previously reported rates of occult DVT are variable, these results are consistent with some of the larger analyses. 4,[14][15][16][17] The 30-day incidence of pulmonary embolism was 2.0% (0.6% to 4.6%), which is consistent with reported outcomes in surgical oncology patients drawing on data from the American College of Surgeons National Surgical Quality Improvement Program. 22 While no pulmonary emboli occurred in patients with occult DVT who were anticoagulated or had a vena cava filter placed, three pulmonary emboli occurred in patients with negative screening duplex and two occurred in patients with distal DVT who were not therapeutically anticoagulated.…”

“…These patients may be accurately identified using various risk assessment models . Indeed, the rate of preexisting DVT is not insignificant amongst surgical patients . Identification of preexisting DVT could influence timing of surgery and allow optimal management of perioperative anticoagulation or selective placement of retrievable vena cava filters but would not identify perioperative events.…”

“…9,10 Recent evidence indicates that patients often harbor occult, asymptomatic deep venous thrombosis (DVT), yet the prevalence of this has been inconsistently reported, ranging from 0% to 42%. [11][12][13][14][15][16][17] Furthermore, while it is increasingly appreciated that a substantial number of symptomatic VTE, including pulmonary emboli, occur following hospital discharge, it is less clear what proportion of these events stem from initially occult thromboses. [18][19][20] To the extent that occult DVTs progress to symptomatic VTE, early detection might afford an opportunity for intervention.…”