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Jessica Crystal*, Nicholas Manguso, James M. Mirocha, Allan W. Silberman
Surgery, Cedars-Sinai Medical Center, Los Angeles, CA

Introduction: Malignancy is a known risk factor for venous thromboembolism (VTE). The risk may vary with the type of malignancy.

Methods: We retrospectively reviewed 464 patients who were operated on by a surgical oncologist for either a history of prior, current, or presumed diagnosis of malignancy from January 2009 through September 2018. Patients with diagnoses of hepatopancreaticobiliary (HPB), sarcoma, colorectal/anal, gastric, GIST, esophageal, and benign tumors were included. These patients received preoperative epidural analgesia without postoperative chemical VTE prophylaxis. Lower extremity venous duplex scans (VDS) were performed pre- and postoperatively. Demographics, procedures, and above the knee VTE outcomes were reviewed.

Results: The incidence of a history of prior VTE was 4.7% (22/464) in all patients, 5.2% (22/423) in the patients with malignancy, and 0% (0/41) in the benign cohort. Preoperative duplex was positive for VTE in 3.4% (16/464) of the patients, 3.5% (15/423) of the malignant cohort, and 2.4% (1/41) in the benign cohort. Postoperative duplex was positive for VTE in 5.0% (23/464) of the patients, 5.4% (22/423) of the patients with malignancy, and 2.4% (1/41) in the benign cohort. New post-op VTE (defined as VTE in patients without any prior history or preoperative VTE) occurred in 1.1% (5/464) of the total patients, 0.9% (4/423) in the malignant cohort, and 2.4% (1/41) in the benign cohort. No patients developed postoperative pulmonary embolism.

The rates of prior VTE varied among histology type, p=0.009. Patients with HPB tumors had the highest prior VTE rate, with a frequency of 19.4% (7/36), while patients with sarcoma had a rate of 5.7% (9/158). Patients with the other malignancies had rates less than 5%. There was a similar pattern for patients who developed preoperative VTE, with HPB having the highest frequency at 13.9% (5/36), but none of the aforementioned malignancies had rates greater than 4%. The varying rates of VTE among these cancer types was not statistically significant, p =0.073. The postoperative VTE rates varied among histology type, p=0.024. Postoperative VTE was highest in HPB tumors with a frequency of 19.4% (7/36), 4.8% (3/63) in patients with gastric cancer, 4.6% (5/108) in patients with colorectal/anal cancer, and less than 4% in the other malignancies. Only 5 patients had new postoperative DVTs. One of these patients had a benign tumor.

Conclusions: Our data suggests that not all patients with malignancies undergoing major oncologic surgery are at the same risk of prior, pre-, and postoperative VTE. However, regardless of histology, they are at increased risk of VTE compared to the benign cohort. Preoperative duplex screening should be considered for these high risk patients.

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