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Original research
Deep vein thrombosis and serum D-dimer after pelvic lymphadenectomy in gynecological cancer
  1. Hiroaki Komatsu1,
  2. Muneaki Shimada2,
  3. Daiken Osaku1,
  4. Imari Deura3,
  5. Shinya Sato1,
  6. Tetsuro Oishi1 and
  7. Tasuku Harada1
  1. 1 Obstetrics and Gynecology, Tottori University, Yonago, Tottori, Japan
  2. 2 Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
  3. 3 Obstetrics and Gynecology, Sei Marianna Ika Daigaku Yokohama-shi Seibu Byoin, Yokohama, Kanagawa, Japan
  1. Correspondence to Dr Hiroaki Komatsu, Obstetrics and Gynecology, Tottori University, Yonago 680-8550, Japan; komatsu.h.med{at}gmail.com; Dr Muneaki Shimada; muneaki.shimada.b7{at}tohoku.ac.jp

Abstract

Introduction Venous thromboembolism prevention during the perioperative period requires comprehensive risk-level assessment. The aim of this study was to evaluate the incidence of deep vein thrombosis and to assess the cut-off levels of serum D-dimer as a screening strategy for deep vein thrombosis during the perioperative period.

Methods A total of 205 patients (ovarian cancer: 68, endometrial cancer: 76, cervical cancer: 61) who underwent gynecological surgery, including retroperitoneal lymph node dissection, were enrolled. We retrospectively analyzed the data on the cut-off value of D-dimer assessed using area under the receiver operating characteristic curve preoperatively, and 2 or 3 months, postoperatively. All patients underwent leg vein ultrasonography regardless of the serum D-dimer level. Furthermore, CT scans were performed to evaluate both disease status and venous thromboembolism, including pulmonary thromboembolism. Statistical analyzes were performed using the Mann–Whitney U-test (D-dimer values of each cancer), Chi-square test, Fisher's exact test (incidence of deep vein thrombosis), and one-way analysis of variance (patient characteristics).

Results A total of 205 patients (ovarian cancer: 68, endometrial cancer: 76, cervical cancer: 61) who underwent gynecological surgery, including retroperitoneal lymph node dissection, were included in the analysis. Deep vein thrombosis rates were significantly higher in patients with ovarian cancer (P<0.001). The postoperative D-dimer value was significantly higher than the preoperative value. Postoperative D-dimer values were also significantly higher in patients who received adjuvant chemotherapy (P=0.001). The cut-off value of D-dimer was 1.55 µg/mL preoperatively (sensitivity, 48.0%; specificity, 94.1%), and this value was higher postoperatively, at 1.95 µg/mL (sensitivity, 37.0%; specificity, 90.9%).

Conclusion Postoperative D-dimer values are higher not only after surgery but also in patients who received adjuvant chemotherapy. The cut-off value of D-dimer at 2 or 3 months postoperatively was higher than preoperative value.

  • venous thromboembolism
  • lymph nodes
  • surgical oncology
  • postoperative period

https://doi.org/10.1136/ijgc-2019-000914

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    Footnotes

    • Contributors HK and MS devised the project, the main conceptual ideas, and proof outline. HK and MS worked out almost all of the technical details and performed numerical calculations for the suggested experiment. HK wrote the manuscript. All authors provided critical feedback and helped shape the research, analysis, and manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available in a public, open access repository. Data are available in a public, open access repository.