Highlights
- •Incidence of 90-day postoperative VTE is low in the MIS population.
- •No apparent difference in rates of VTE across MIS modalities.
- •Increased OR time is associated with increased risk of 90-day postoperative VTE.
- •Extended VTE chemoprophylaxis is unnecessary for Gyn Onc patients following MIS.
Abstract
Objectives
Minimally invasive surgery (MIS) is increasingly utilized for gynecologic cancers.
While incidence of venous thromboembolism (VTE) after MIS is low, some guidelines
recommend extended chemoprophylaxis for these patients undergoing MIS. Our objectives
were to determine incidence of postoperative VTE in patients undergoing MIS, evaluate
differences in the incidence by MIS modality and assess the need for extended chemoprophylaxis.
Methods
We conducted a retrospective cohort study including all patients undergoing MIS (robot-assisted,
multi-port laparoscopy, single-port laparoscopy) for gynecologic cancers between January
2014 and December 2018 at our institution. Demographic and perioperative variables
were collected. Patients <18 years, with benign pathology, or on preoperative anticoagulation
were excluded. Chi-square, Fisher's exact test, and one-way ANOVA were performed to
determine risk factors related to VTE occurrence.
Results
We identified 806 patients who underwent MIS with median age 61. Most had Stage I
disease (81.5%) and uterine cancer (81.5%). Five VTE events occurred within 90 days
following surgery (0.6%). Incidence of 90-day VTE did not differ between MIS modalities
(p = 0.6). Patients with longer OR times (p = 0.004) were more likely to experience VTE. Age, smoking status, BMI, type of cancer
and stage were not significant risk factors for VTE.
Conclusions
The incidence of postoperative VTE in patients with gynecologic cancers undergoing
MIS is low and does not appear to differ by MIS modality. Given the very low incidence
of postoperative VTE, extended chemoprophylaxis is unlikely to benefit patients with
gynecologic malignancies undergoing MIS procedures.
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Article info
Publication history
Published online: June 17, 2021
Accepted:
June 13,
2021
Received:
March 20,
2021
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
