Journal
LANGENBECKS ARCHIVES OF SURGERY
Volume 407, Issue 2, Pages 597-608Publisher
SPRINGER
DOI: 10.1007/s00423-021-02315-5
Keywords
Venous thromboembolism; Pulmonary embolism; Minimally invasive surgery; Gastric neoplasm; Ultrasonography
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Preoperative screening for DVT using lower-extremity ultrasonography followed by preoperative anticoagulant therapy can effectively reduce the incidence of VTE after minimally invasive surgery for gastric cancer. Age over 70 years, female sex, and positive serum D-dimer were significant independent risk factors for preoperative DVT. The incidence of symptomatic postoperative VTE was very low.
Purpose This study aimed to investigate the clinical efficacy of lower-extremity ultrasonography screening with early intervention for deep venous thrombosis (DVT) on the incidence of venous thromboembolism (VTE) after minimally invasive surgery (MIS) for gastric cancer (GC). Methods Between January 2012 and December 2019, 1070 patients were diagnosed with both clinical and pathological stage I-III GC and underwent MIS at our institution. Routine ultrasonographic screening for DVT in lower extremities is performed before MIS. Patients diagnosed with DVT were preoperatively administered anticoagulant therapy. Enoxaparin was routinely administrated after surgery irrespective of the presence of DVT. The incidence of postoperative symptomatic VTE was examined retrospectively. Results A total of 74 (6.9%) patients were preoperatively diagnosed with DVT. Multivariate analyses revealed that age > 70 years (p = 0.015), female sex (p < 0.001), and positive serum D-dimer test (p < 0.001) were significant and independent risk factors for preoperative DVT. The incidence of symptomatic postoperative VTE was 1 (0.09%); symptomatic VTE developed in one patient among patients without DVT, whereas no patient with DVT developed VTE. Conclusions Preoperative DVT screening using lower-extremity ultrasonography followed by preoperative anticoagulant therapy should be considered as a useful strategy to safely perform MIS for GC without increasing the incidence of VTE.
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