Skip to main content
SpringerLink
Log in

Clinical analysis of postoperative venous thromboembolism in Japanese patients after colorectal cancer surgery

  • Original Article
  • Published:
Surgery Today Aims and scope Submit manuscript

Abstract

Purpose

Venous thromboembolism (VTE) is a major complication after abdominal surgery; however, the best strategy for preventing VTE after surgery is not yet established. We performed this study to investigate the incidence of perioperative VTE and evaluate the efficacy of a VTE preventive strategy for patients undergoing surgery for colorectal cancer (CRC).

Methods

The subjects of this retrospective analysis were 228 patients who underwent curative surgical resection for CRC between 2012 and 2016. The patients were treated with thromboprophylaxis including enoxaparin. We assessed the perioperative VTE occurrence rate and investigated the risk factors for postoperative VTE.

Results

Among the 228 patients, 77 had a preoperative D-dimer level of > 1.0 μg/mL and 12 had deep vein thrombosis (DVT) diagnosed by ultrasonography preoperatively. Of the remaining 216 patients, short-term VTE (< 30 days) developed in two patients (0.9%) and long-term VTE (30 days–3 years) developed in seven (3.2%). The mortality rate of patients with VTE was 0%. The univariate analysis indicated that pulmonary disease was the risk factor for short-term VTE, whereas obesity, hyperlipidemia, and a preoperative history of pulmonary embolism were the risk factors for long-term VTE (p < 0.05).

Conclusion

The findings of this analysis show that our preventive protocol including enoxaparin is an effective strategy for preventing postoperative VTE.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Abbreviations

DVT:

Deep vein thrombosis

PE:

Pulmonary embolism

VTE:

Venous thromboembolism

LDUH:

Low-dose unfractionated heparin

LMWH:

Low-molecular-weight heparin

CRC:

Colorectal cancer

US:

Ultrasonography

RCT:

Randomized controlled trial

DOAC:

Direct oral anticoagulants

CT:

Computed tomography

References

  1. Emoto S, Nozawa H, Kawai K, Hata K, Tanaka T, Shuno Y, et al. Venous thromboembolism in colorectal surgery: incidence, risk factors, and prophylaxis. Asian J Surg. 2019;42:863–73.

    Article  Google Scholar 

  2. Hisada Y, Mackman N. Cancer-associated pathways and biomarkers of venous thrombosis. Blood. 2017;130(13):1499–506.

    Article  CAS  Google Scholar 

  3. Gould MK, Garcia DA, Wren SM, Karanicolas PJ, Arcelus JI, Heit JA, 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:e227S-e277S.

    Article  CAS  Google Scholar 

  4. Kurita N, Shimada M, Takashi I, et al. A Randomized study of anti-thrombotic prophylaxis to prevent postoperative venous thromboembolism (in Japanese with English abstract). Nihon Hukubukyukyuzasshi (J Abdom Emerg Med). 2013;33:1119–24.

    Google Scholar 

  5. Nakagawa K, Watanabe J, Suwa Y, Suzuki S, Ishibe A, Ota M, et al. Clinical analysis of preoperative deep vein thrombosis risk factors in patients with colorectal cancer: retrospective observational study. Ann Gastroenterol Surg. 2019;3(4):451–8.

    Article  Google Scholar 

  6. ENOXACAN Study Group. Efficacy and safety of enoxaparin versus unfractionated heparin for prevention of deep vein thrombosis in elective cancer surgery: a double-blind randomized multicentre trial with venographic assessment. Br J Surg. 1997;84(8):1099–103.

    Article  Google Scholar 

  7. McLeod RS, Geerts WH, Sniderman KW, Greenwood C, Gregoire RC, Taylor BM, et al. Subcutaneous heparin versus low-molecular-weight heparin as thromboprophylaxis in patients undergoing colorectal surgery: results of the canadian colorectal DVT prophylaxis trial: a randomized, double-blind trial. Ann Surg. 2001;233:438–44.

    Article  CAS  Google Scholar 

  8. Nakagawa K, Watanabe J, Ota M, Suwa Y, Suzuki S, Suwa H, et al. Efficacy and safety of enoxaparin for preventing venous thromboembolic events after laparoscopic colorectal cancer surgery: a randomized-controlled trial (YCOG 1404). Surg Today. 2020;50(1):68–75.

    Article  Google Scholar 

  9. Davenport DL, Vargas HD, Kasten MW, Xenos ES. Timing and perioperative risk factors for in-hospital and post-discharge venous thromboembolism after colorectal cancer resection. Clin Appl Thromb Hemost. 2012;18:569–75.

    Article  Google Scholar 

  10. Xenos ES, Vargas HD, Davenport DL. Association of blood transfusion and venous thromboembolism after colorectal cancer resection. Thromb Res. 2012;129:568–72.

    Article  CAS  Google Scholar 

  11. Walker AJ, West J, Card TR, Humes DJ, Grainge MJ. Variation in the risk of venous thromboembolism in people with colorectal cancer: a population-based cohort study from England. J Thromb Haemost. 2014;12:641–9.

    Article  CAS  Google Scholar 

  12. Kuroiwa M, Morimatsu H, Tsuzaki K, Irita K, Sanuki M, Nakatsuka H, et al. Changes in the incidence, case fatality rate, and characteristics of symptomatic perioperative pulmonary thromboembolism in Japan: Results of the 2002–2011 Japanese Society of Anesthesiologists Perioperative Pulmonary Thromboembolism (JSA-PTE) Study. J Anesth. 2015;29(3):433–41.

    Article  Google Scholar 

  13. Khalafallah AA, Kirkby BE, Wong S, Foong YC, Ranjan N, Luttrell J, et al. Venous thromboembolism in medical patients during hospitalisation and 3 months after hospitalisation: a prospective observational study. BMJ Open. 2016;6:e012346.

    Article  Google Scholar 

  14. Kuderer NM, Poniewierski MS, Culakova E, Lyman GH, Khorana AA, Pabinger I, et al. Predictors of venous thromboembolism and early mortality in lung cancer: results from a global prospective study (CANTARISK). Oncologist. 2018;23:247–55.

    Article  Google Scholar 

  15. Shah DR, Wang H, Bold RJ, Xiaowei Y, Steve RM, Anthony DY, et al. Nomograms to predict risk of in-hospital and post-discharge venous thromboembolism after abdominal and thoracic surgery: an American College of Surgeons National Surgical Quality Improvement Program analysis. J Surg Res. 2013;183:462–71.

    Article  Google Scholar 

  16. Shin WC, Woo SH, Lee SJ, Lee JS, Kim C, Suh KT. Preoperative prevalence of and risk factors for venous thromboembolism in patients with a hip fracture: an indirect multidetector CT venography study. J Bone Joint Surg Am. 2016;98:2089–95.

    Article  Google Scholar 

  17. Yan SF, Mackman N, Kisiel W, Stern DM, Pinsky DJ. Hypoxia/Hypoxemia-Induced activation of the procoagulant pathways and the pathogenesis of ischemia-associated thrombosis. Arterioscler Thromb Vasc Biol. 1999;19:2029–35.

    Article  CAS  Google Scholar 

  18. Sogawa Y, Yoshimine F, Hanzawa K. The risk of deep vein thrombosis of the lower extremities in patients with chronic respiratory disorders, based on the results of ultrasonography screening (in Japanese with English abstract). Rehabilitation Igaku (Jpn J Rehabil Med). 2008;45:40–5.

    Google Scholar 

  19. Fünfsinn N, Caliezi C, Biasiutti FD, Korte W, Z’Brun A, Baumgartner I, et al. Rapid D-dimer testing and pre-test clinical probability in the exclusion of deep venous thrombosis in symptomatic outpatients. Blood Coagul Fibrinolysis. 2001;12(3):165–70.

    Article  Google Scholar 

  20. White RH, McGahan JP, Daschbach MM, Hartling RP. Diagnosis of deep-vein thrombosis using duplex ultrasound. Ann Intern Med. 1989;111(4):297–304.

    Article  CAS  Google Scholar 

  21. The Japanese Circulation Society (JCS). Guidelines for Diagnosis, Treatment and Prevention of Pulmonary Thromboembolism and Deep Vein Thrombosis (JCS 2017) (in Japanese). 2018. https://j-circ.or.jp/old/guideline/pdf/JCS2017_ito_h.pdf. Accessed 7 Oct 2020.

  22. Horsted F, West J, Grainge MJ. Risk of venous thromboembolism in patients with cancer: a systematic review and meta-analysis. PLoS Med. 2012;9(7):e1001275.

    Article  Google Scholar 

Download references

Funding

None.

Author information

Authors and Affiliations

  1. Department of Digestive and Transplant Surgery, Tokushima University, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan

    Shoko Yamashita, Masaaki Nishi, Tetsuya Ikemoto, Kozo Yoshikawa, Jun Higashijima, Takuya Tokunaga, Chie Takasu, Hideya Kashihara, Shohei Eto, Toshiaki Yoshimoto & Mitsuo Shimada

  2. Division for Patients’ Safety, Tokushima University, Tokushima, Japan

    Tetsuya Ikemoto

Authors
  1. Shoko Yamashita
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Masaaki Nishi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tetsuya Ikemoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kozo Yoshikawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jun Higashijima
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Takuya Tokunaga
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Chie Takasu
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Hideya Kashihara
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Shohei Eto
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Toshiaki Yoshimoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Mitsuo Shimada
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Masaaki Nishi.

Ethics declarations

Conflict of interest

We have no conflicts of interest to declare.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yamashita, S., Nishi, M., Ikemoto, T. et al. Clinical analysis of postoperative venous thromboembolism in Japanese patients after colorectal cancer surgery. Surg Today 51, 1022–1027 (2021). https://doi.org/10.1007/s00595-020-02201-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00595-020-02201-5

Keywords

Search

Navigation