Routine surveillance for diagnosis of venous thromboembolism after pleurectomy for malignant pleural mesothelioma

Abstract

Objective-The purpose of this study was to determine the incidence of venous thromboembolism and utility of a routine surveillance program in patients undergoing surgery for mesothelioma.Methods-Patients undergoing pleurectomy from May 2016 to August 2018 were included. A standardized surveillance program to look for venous thromboembolism in this group included noninvasive studies every 7 days postoperatively or earlier if symptomatic. All patients received external pneumatic compression sleeves in addition to prophylactic heparin. If deep vein thrombosis or pulmonary embolus was discovered, heparin drip was initiated until conversion to therapeutic anticoagulation.Results-A total of 100 patients underwent pleurectomy for mesothelioma. Seven patients were found to have preoperative deep vein thrombosis, and as such only 93 patients were included for analysis. The median age of patients at surgery was 71 years (30-85 years). During the study, 30 patients (32%) developed evidence of thrombosis; 20 patients (22%) developed only deep vein thrombosis without embolism, 3 patients (3%) developed only pulmonary embolism, and 7 patients (7%) developed both deep vein thrombosis and pulmonary embolus. Of the 27 patients who developed deep vein thrombosis, 9 (33%) were asymptomatic at the time of diagnosis, and none of these developed a pulmonary embolus or other bleeding complications. There were 2 (2%) events of major postoperative bleeding related to therapeutic anticoagulation.Conclusions-The incidence of venous thromboembolism is high (32%) among patients undergoing surveillance after pleurectomy for mesothelioma. Up to 33% of patients with deep vein thrombosis are asymptomatic at the time of diagnosis, and the incidence of complications related to anticoagulation is low. Routine surveillance may be useful to diagnose and treat deep vein thrombosis before it progresses to symptomatic or fatal pulmonary embolus.

Hyperthermic intraoperative chemotherapy (HIOC) for Stage IVa thymic malignancy may improve 5‐year disease‐free survival

“…Interestingly, the rate of symptomatic deep venous thrombosis at 8.8% (3/34) in this study is lower than recently reported data for pleurectomy and decortication of mesothelioma alone, 19.4% (18/93) 18 . This lower rate is despite the lack of chemotherapy use and different tumor biology.…”

The Role of Surgery in Pleural Mesothelioma

“…Alteration in surgical technique from EPP to PD [59] 3. Decreasing perioperative complications by implementing strategies to minimize occurrences of deep vein thrombosis (DVT) and pulmonary embolism (PE) through routine surveillance measures and early detection of nonclinical events [57]. Additionally, addressing issues like prolonged air leaks and empyema by meticulously repairing all lung lacerations by stapling or over-sewing with sutures [68], and prioritizing primary repair of the diaphragm whenever feasible, avoiding resection and reconstruction with a prosthetic patch [55].…”

“…Notably, as many as 33% of patients with deep vein thrombosis were asymptomatic at the time of diagnosis. De Leon et al suggested that routine surveillance could be beneficial in identifying and managing deep vein thrombosis before it advances to symptomatic or fatal pulmonary embolus [57].…”