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Background: The association between venous thromboembolism and chemotherapy for esophagogastric cancer is well known in patients treated with palliative intent. Whether this risk extends to the neoadjuvant and perioperative setting is unclear.
Methods: Retrospective interrogation of databases of patients receiving perioperative chemotherapy for potentially curative intent at the Leicester (2006-2011) and Nottingham (2004-2011) esophagogastric cancer centres.
Results: Thromboembolic events were diagnosed in 42 of 384 patients (11%), 16 (4%) at presentation, 14 (4%) during neodjuvant chemotherapy and 12 (3%) in the postoperative period. By site these comprised catheter-related axillary vein thrombosis in 6 patients, deep venous thrombosis in 16 patients and pulmonary embolism in 16 patients. All of the pulmonary emboli were incidental findings on staging CT imaging. There was no correlation between the risk of thromboembolism and chemotherapy regimen. Seven of the 42 patients (17%) who developed thromboembolism did not proceed to surgery because of deterioration in performance status. Thromboembolic disease resulted in a non-significant increase in the interval between chemotherapy and surgery, but did not influence either length of hospital stay or survival.
Conclusions: Eleven percent of patients treated with potentially curative intent will develop venous thromboembolism. This adverse event can occur at any time during the patient journey. In contrast to the commonly held view, this did not translate into a poorer prognosis.