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Risk factors for venous thrombosis after esophagectomy

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Abstract

Background

Venous thrombosis (VT) after esophagectomy for esophageal cancer is an important complication, potentially leading to pulmonary embolism. However, there are few available information about the risk for the postsurgical VT.

Methods

This study included 271 patients who underwent esophagectomy for esophageal cancer between 2006 and 2019. Contrast-enhanced computed tomography (CT) was performed for all patients on the seventh postoperative day to survey complications, including VT.

Results

VT was radiologically visualized in 48 patients (17.7%), 8 of whom (16.7%) had pulmonary embolism. The thrombus disappeared in 42 patients, the thrombus size was unchanged in 5 patients, and 1 patient died. Multivariate analysis was performed on factors clinically considered to have a significant influence on thrombus formation. The analysis showed that CVC insertion via the femoral vein (odds ratio, 7.67; 95% CI, 2.64–22.27; P < 0.001), retrosternal reconstruction route (odds ratio, 3.94; 95% CI, 1.90–8.17; P < 0.001) and intraoperative fluid balance < 5 ml/kg/hr (odds ratio, 0.38; 95% CI, 0.17–0.85; P = 0.019) were independently related to VT.

Conclusions

Intraoperative fluid balance < 5 ml/kg/hr, along with CVC insertion via the femoral vein and retrosternal reconstruction may be potential risk factors for VT after esophagectomy.

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Data availability

The data that support the findings of this study are available from the corresponding author, Kazushi Miyata, upon reasonable request.

References

  1. Ohkura Y, Miyata H, Konno H, Udagawa H, Ueno M, Shindoh J, et al. Development of a model predicting the risk of eight major postoperative complications after esophagectomy based on 10 826 cases in the Japan national clinical database. J Surg Oncol. 2020;121:313–21.

    Article  PubMed  Google Scholar 

  2. Martin JT, Mahan AL, Ferraris VA, Saha SP, Mullett TW, Zwischenberger JB, The Society of Thoracic Surgeons, et al. Identifying esophagectomy patients at risk for predischarge versus postdischarge venous thromboembolism. Ann Thorac Surg. 2015;100:932–8.

    Article  PubMed  Google Scholar 

  3. Bellini G, Teng A, Kotecha N, Sutton E, Yang CK, Passeri M, et al. The identification of risk factors for venous thromboembolism in gastrointestinal oncologic surgery. J Surg Res. 2016;205:279–85.

    Article  PubMed  Google Scholar 

  4. Hammond J, Kozma C, Hart JC, Nigam S, Daskiran M, Paris A, et al. Rates of venous thromboembolism among patients with major surgery for cancer. Ann Surg Oncol. 2011;18:3240–7.

    Article  PubMed  Google Scholar 

  5. Ando N, Kato H, Igaki H, Shinoda M, Ozawa S, Shimizu H, et al. A randomized trial comparing postoperative adjuvant chemotherapy with cisplatin and 5-fluorouracil versus preoperative chemotherapy for localized advanced squamous cell carcinoma of the thoracic esophagus (JCOG9907). Ann Surg Oncol. 2012;19:68–74.

    Article  PubMed  Google Scholar 

  6. Watanabe M, Tachimori Y, Oyama T, Toh Y, Matsubara H, Ueno M, et al. Comprehensive registry of esophageal cancer in Japan, 2013. Esophagus. 2021;18:1–24.

    Article  PubMed  Google Scholar 

  7. Takahashi T, Fukaya M, Miyata K, Sakatoku Y, Nagino M. Retrosternal reconstruction can be a risk factor for upper extremity deep vein thrombosis after esophagectomy. World J Surg. 2017;41:3154–63.

    Article  PubMed  Google Scholar 

  8. Medical Research Council Oesophageal Cancer Working Group. Surgical resection with or without preoperative chemotherapy in oesophageal cancer: a randomised controlled trial. Lancet (London, England). 2002;359:1727–33.

    Article  Google Scholar 

  9. Allum WH, Stenning SP, Bancewicz J, Clark PI, Langley RE. Long-term results of a randomized trial of surgery with or without preoperative chemotherapy in esophageal cancer. J Clin Oncol. 2009;27:5062–7.

    Article  PubMed  Google Scholar 

  10. Maeda O, Fukaya M, Koike M, Miyata K, Kanda M, Nishida K, et al. Preoperative docetaxel, cisplatin, and fluorouracil treatment with pegfilgrastim on day 7 for patients with esophageal cancer: a phase II study. Asia Pac J Clin Oncol. 2022;18:578–85.

    Article  PubMed  Google Scholar 

  11. Merrer J, De Jonghe B, Golliot F, Lefrant JY, Raffy B, Barre E, et al. Complications of femoral and subclavian venous catheterization in critically ill patients: a randomized controlled trial. JAMA. 2001;286:700–7.

    Article  CAS  PubMed  Google Scholar 

  12. Fujiwara Y, Yamatsuji T, Tanabe S, Sakurama K, Motoki T, Takaoka M, et al. Utilization of partition analysis to evaluate the incidence on deep vein thrombosis following esophagectomy. Esophagus. 2013;10:1–5.

    Article  Google Scholar 

  13. Parienti J-J, Mongardon N, Mégarbane B, Mira J-P, Kalfon P, Gros A, et al. Intravascular complications of central venous catheterization by insertion site. N Engl J Med. 2015;373:1220–9.

    Article  CAS  PubMed  Google Scholar 

  14. Shires T, Williams J, Brown F. Acute change in extracellular fluids associated with major surgical procedures. Ann Surg. 1961;154:803–10.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Ferrando C, Soro M, Unzueta C, Canet J, Tusman G, Suarez-Sipmann F, et al. Rationale and study design for an individualised perioperative open-lung ventilatory strategy with a high versus conventional inspiratory oxygen fraction (iPROVE-O2) and its effects on surgical site infection: study protocol for a randomised controlled tr. BMJ Open. 2017;7: e016765.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Arkiliç CF, Taguchi A, Sharma N, Ratnaraj J, Sessler DI, Read TE, et al. Supplemental perioperative fluid administration increases tissue oxygen pressure. Surgery. 2003;133:49–55.

    Article  PubMed  Google Scholar 

  17. Brandstrup B, Tønnesen H, Beier-Holgersen R, Hjortsø E, Ørding H, Lindorff-Larsen K, et al. Effects of intravenous fluid restriction on postoperative complications: comparison of two perioperative fluid regimens: a randomized assessor-blinded multicenter trial. Ann Surg. 2003;238:641–8.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Nisanevich V, Felsenstein I, Almogy G, Weissman C, Einav S, Matot I. Effect of intraoperative fluid management on outcome after intraabdominal surgery. Anesthesiology. 2005;103:25–32.

    Article  PubMed  Google Scholar 

  19. Lobo DN, Bostock KA, Neal KR, Perkins AC, Rowlands BJ, Allison SP. Effect of salt and water balance on recovery of gastrointestinal function after elective colonic resection: a randomised controlled trial. Lancet (London, England). 2002;359:1812–8.

    Article  PubMed  Google Scholar 

  20. Gustafsson UO, Scott MJ, Schwenk W, Demartines N, Roulin D, Francis N, et al. Guidelines for perioperative care in elective colonic surgery: enhanced recovery after surgery (ERAS®) Society recommendations. Clin Nutr Elsevier Ltd. 2012;31:783–800.

    Article  CAS  Google Scholar 

  21. Feldheiser A, Aziz O, Baldini G, Cox BPBW, Fearon KCH, Feldman LS, et al. Enhanced recovery after surgery (ERAS) for gastrointestinal surgery, part 2: consensus statement for anaesthesia practice. Acta Anaesthesiol Scand. 2016;60:289–334.

    Article  CAS  PubMed  Google Scholar 

  22. Ljungqvist O, Scott M, Fearon KC. Enhanced recovery after surgery: a review. JAMA Surg. 2017;152:292–8.

    Article  PubMed  Google Scholar 

  23. Corcoran T, Rhodes JEJ, Clarke S, Myles PS, Ho KM. Perioperative fluid management strategies in major surgery: a stratified meta-analysis. Anesth Analg. 2012;114:640–51.

    Article  PubMed  Google Scholar 

  24. Myles PS, Bellomo R, Corcoran T, Forbes A, Peyton P, Story D, et al. Restrictive versus liberal fluid therapy for major abdominal surgery. N Engl J Med. 2018;378:2263–74.

    Article  PubMed  Google Scholar 

  25. Arieff AI. Fatal postoperative pulmonary edema: pathogenesis and literature review. Chest. 1999;115:1371–7.

    Article  CAS  PubMed  Google Scholar 

  26. Yoshida N, Baba Y, Miyamoto Y, Iwatsuki M, Hiyoshi Y, Ishimoto T, et al. Prophylaxis of postoperative venous thromboembolism using enoxaparin after esophagectomy: a prospective observational study of effectiveness and safety. Ann Surg Oncol. 2018;25:2434–40.

    Article  PubMed  Google Scholar 

  27. Tanaka Y, Yamada A, Hirata S, Tanaka H, Sakuratani T, Matsuhashi N, et al. Efficacy and safety of enoxaparin for prophylaxis of postoperative venous thromboembolism after esophagectomy: a single-center prospective randomized controlled phase II study. Anticancer Res. 2019;39:2615–25.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan

    Naoya Torii, Kazushi Miyata, Masahide Fukaya & Tomoki Ebata

Authors
  1. Naoya Torii
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  2. Kazushi Miyata
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  3. Masahide Fukaya
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  4. Tomoki Ebata
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Correspondence to Kazushi Miyata.

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Ethical Statement

This retrospective study was approved by the ethical committee of Nagoya University Hospital (approved No. 2020–0328).

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Torii, N., Miyata, K., Fukaya, M. et al. Risk factors for venous thrombosis after esophagectomy. Esophagus 21, 150–156 (2024). https://doi.org/10.1007/s10388-023-01038-4

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  • DOI: https://doi.org/10.1007/s10388-023-01038-4

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