Annals of Surgical Oncology

, Volume 25, Issue 11, pp 3214–3221 | Cite as

Venous Thromboembolic Events Following Major Pelvic and Abdominal Surgeries for Cancer: A Prospective Cohort Study

  • Pablo E. SerranoEmail author
  • Sameer Parpia
  • Lori-Ann Linkins
  • Laurie Elit
  • Marko Simunovic
  • Leyo Ruo
  • Mohit Bhandari
  • Mark Levine
Gastrointestinal Oncology



The aim of this study was to evaluate the incidence and risk factors for post-hospital discharge venous thromboembolism (VTE) following abdominal cancer surgery without post-discharge prophylaxis.


This was a single-center, prospective cohort study. Patients were evaluated at 1, 3, and 6 months from surgery for the presence of proximal deep vein thrombosis (DVT; screening ultrasound at 1 month and questionnaire at each visit). Cumulative VTE incidence with 95% confidence interval (CI) was estimated using Kaplan–Meier methods, and multivariable analysis was performed using a Cox proportional hazards model.


Of 284 patients enrolled, 79 (28%) underwent colorectal laparotomy, 97 (34%) underwent hepatobiliary laparotomy, 100 (35%) underwent gynecological laparotomy, and 8 (3%) underwent exploratory laparotomy without resection. All patients received pre- and postoperative inpatient prophylaxis. The cumulative incidence of VTE at 1 month was 0.35% (95% CI 0.05–2.48), 2.5% at 3 months (95% CI 1.19–5.15), and 7.2% at 6 months (95% CI 4.72–10.97). Screening ultrasound performed 4 weeks after surgery in 50% of patients was negative for thrombosis in all cases. Event distribution was similar according to the type of surgery (open/laparoscopic) and type of cancer. Seventeen (6.6%) patients died (95% CI 3.5–9.4) (two had a VTE-related death). Postoperative chemotherapy and Caprini score were significantly associated with VTE [hazard ratios 3.77 (95% CI 1.56–9.12) and 1.17 (95% CI 1.02–1.34), respectively].


The incidence of post-hospital discharge proximal DVT and/or symptomatic VTE following abdominal and pelvic cancer surgery appears to be low. The cumulative number of events increased at 6 months, but this was likely due to additional risk factors that were not related to surgery. Postoperative chemotherapy increases the risk of VTE.



This study was supported in part by a grant from the Juravinski Hospital and Cancer Centre Foundation and McMaster Surgical Associates. The funding covered data management and study coordination. The granting agency had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. Approval of the manuscript and the decision to submit the manuscript for publication were made by the steering committee. All authors have provided written permission. Pablo E. Serrano had full access to all the data in the study and takes full responsibility for the integrity of the data and accuracy of the data analysis. Pablo E. Serrano and Sameer Parpia conducted, and are responsible for, the data analysis.

Conflict of interest

Pablo E. Serrano, Sameer Parpia, Lori-Ann Linkins, Laurie Elit, Marko Simunovic, Leyo Ruo, Mohit Bhandari, and Mark Levine report no conflicts of interest.

Supplementary material

10434_2018_6671_MOESM1_ESM.tiff (43 kb)
Supplementary material 1 (TIFF 43 kb)
10434_2018_6671_MOESM2_ESM.tiff (67 kb)
Supplementary material 2 (TIFF 67 kb)


  1. 1.
    Geerts WH, Bergqvist D, Pineo GF, et al. Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest. 2008;133(6 Suppl):381S–453S.CrossRefGoogle Scholar
  2. 2.
    Geerts WH, Pineo GF, Heit JA, et al. Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. 2004;126(3 Suppl):338S–400S.CrossRefGoogle Scholar
  3. 3.
    Lyman GH. Venous thromboembolism in the patient with cancer: focus on burden of disease and benefits of thromboprophylaxis. Cancer. 2011;117(7):1334–49.CrossRefGoogle Scholar
  4. 4.
    Haddad TC, Greeno EW. Chemotherapy-induced thrombosis. Thromb Res. 2006;118(5):555–68.CrossRefGoogle Scholar
  5. 5.
    Anderson FA Jr, Wheeler HB, Goldberg RJ, et al. A population-based perspective of the hospital incidence and case-fatality rates of deep vein thrombosis and pulmonary embolism. The Worcester DVT Study. Arch Intern Med. 1991;151(5):933–8.CrossRefGoogle Scholar
  6. 6.
    Nick AM, Schmeler KM, Frumovitz MM, et al. Risk of thromboembolic disease in patients undergoing laparoscopic gynecologic surgery. Obstet Gynecol. 2010;116(4):956–61.CrossRefGoogle Scholar
  7. 7.
    Prescott LS, Kidin LM, Downs RL, et al. Improved compliance with venous thromboembolism pharmacologic prophylaxis for patients with gynecologic malignancies hospitalized for nonsurgical indications did not reduce venous thromboembolism incidence. Int J Gynecol Cancer. 2015;25(1):152–9.CrossRefGoogle Scholar
  8. 8.
    Wille-Jorgensen P, Rasmussen MS, Andersen BR, Borly L. Heparins and mechanical methods for thromboprophylaxis in colorectal surgery. Cochrane Database Syst Rev. 2001;(3):CD001217.Google Scholar
  9. 9.
    Wille-Jorgensen P, Thorup J, Fischer A, Holst-Christensen J, Flamsholt R. Heparin with and without graded compression stockings in the prevention of thromboembolic complications of major abdominal surgery: a randomized trial. Br J Surg. 1985;72(7):579–81.CrossRefGoogle Scholar
  10. 10.
    Schmeler KM, Wilson GL, Cain K, et al. Venous thromboembolism (VTE) rates following the implementation of extended duration prophylaxis for patients undergoing surgery for gynecologic malignancies. Gynecol Oncol. 2013;128(2):204–8.CrossRefGoogle Scholar
  11. 11.
    Akl EA, Terrenato I, Barba M, Sperati F, Muti P, Schunemann HJ. Extended perioperative thromboprophylaxis in patients with cancer: a systematic review. Thromb Haemost. 2008;100(6):1176–80.PubMedGoogle Scholar
  12. 12.
    Lausen I, Jensen R, Jorgensen LN, et al. Incidence and prevention of deep venous thrombosis occurring late after general surgery: randomised controlled study of prolonged thromboprophylaxis. Eur J Surg. 1998;164(9):657–63.CrossRefGoogle Scholar
  13. 13.
    Rasmussen MS, Jorgensen LN, Wille-Jorgensen P, et al. Prolonged prophylaxis with dalteparin to prevent late thromboembolic complications in patients undergoing major abdominal surgery: a multicenter randomized open-label study. J Thromb Haemost. 2006;4(11):2384–90.CrossRefGoogle Scholar
  14. 14.
    Bergqvist D, Agnelli G, Cohen AT, et al. Duration of prophylaxis against venous thromboembolism with enoxaparin after surgery for cancer. N Engl J Med. 2002;346(13):975–80.CrossRefGoogle Scholar
  15. 15.
    Kakkar VV, Balibrea JL, Martinez-Gonzalez J, Prandoni P; CANBESURE Study Group. Extended prophylaxis with bemiparin for the prevention of venous thromboembolism after abdominal or pelvic surgery for cancer: the CANBESURE randomized study. J Thromb Haemost. 2010;8(6):1223–29.CrossRefGoogle Scholar
  16. 16.
    Vedovati MC, Becattini C, Rondelli F, et al. A randomized study on 1-week versus 4-week prophylaxis for venous thromboembolism after laparoscopic surgery for colorectal cancer. Ann Surg. 2014;259(4):665–9.CrossRefGoogle Scholar
  17. 17.
    Rasmussen MS, Jorgensen LN, Wille-Jorgensen P. Prolonged thromboprophylaxis with low molecular weight heparin for abdominal or pelvic surgery. Cochrane Database Syst Rev. 2009;(1):CD004318.Google Scholar
  18. 18.
    Gould MK, Garcia DA, Wren SM, et al. Prevention of VTE in nonorthopedic surgical patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2 Suppl):e227S–77S.CrossRefGoogle Scholar
  19. 19.
    Schulman S, Angeras U, Bergqvist D, et al. Definition of major bleeding in clinical investigations of antihemostatic medicinal products in surgical patients. J Thromb Haemost. 2010;8(1):202–4.CrossRefGoogle Scholar
  20. 20.
    Caprini JA. Thrombosis risk assessment as a guide to quality patient care. Dis-a-Month. 2005;51(2–3):70–8.CrossRefGoogle Scholar
  21. 21.
    Kanda Y. Statistical analysis using freely-available “EZR (Easy R)” software [in Japanese]. Rinsho Ketsueki. 2015;56(10):2258–66.PubMedGoogle Scholar
  22. 22.
    Vendler MMI, Haidari TA, Waage JE, et al. Incidence of venous thromboembolic events in enhanced recovery after surgery for colon cancer: a retrospective, population-based cohort study. Colorectal Dis. 2017;19(11):O393–401.CrossRefGoogle Scholar
  23. 23.
    Cool RM, Herrington JD, Wong L. Recurrent peripheral arterial thrombosis induced by cisplatin and etoposide. Pharmacotherapy. 2002;22(9):1200–04.CrossRefGoogle Scholar
  24. 24.
    Togna GI, Togna AR, Franconi M, Caprino L. Cisplatin triggers platelet activation. Thrombo Res. 2000;99(5):503–9.CrossRefGoogle Scholar
  25. 25.
    Walsh J, Wheeler HR, Geczy CL. Modulation of tissue factor on human monocytes by cisplatin and adriamycin. Br J Haematol. 1992;81(4):480–8.CrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2018

Authors and Affiliations

  • Pablo E. Serrano
    • 1
    • 2
    Email author
  • Sameer Parpia
    • 3
    • 4
  • Lori-Ann Linkins
    • 5
  • Laurie Elit
    • 3
    • 4
    • 6
  • Marko Simunovic
    • 1
    • 2
    • 4
  • Leyo Ruo
    • 1
    • 2
  • Mohit Bhandari
    • 1
    • 4
  • Mark Levine
    • 2
    • 3
  1. 1.Department of Surgery, Juravinski HospitalMcMaster UniversityHamiltonCanada
  2. 2.Hamilton Health SciencesHamiltonCanada
  3. 3.Department of OncologyMcMaster UniversityHamiltonCanada
  4. 4.Department of Health Research Methods, Evidence and ImpactMcMaster UniversityHamiltonCanada
  5. 5.Division of Hematology and Thromboembolism, Department of MedicineMcMaster UniversityHamiltonCanada
  6. 6.Department of Obstetrics and GynecologyMcMaster UniversityHamiltonCanada

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