Introduction/Background*Gynaecological cancer surgery carries a high risk of venous thromboembolism (VTE). In the absence of thromboprophylaxis, 34.5% of women with gynaecological cancer develop VTE post operatively compared to 2% in benign gynaecological surgery patients. Lymph node dissection (LND), an integral part of any gynaecological procedure, carries therapeutic benefit in some cancers but also increases the complications of cancer surgery. An association of LND with VTE has been suggested.
The aim of this study is to investigate the role of LND and lymph node (LN) metastasis on the incidence of VTE following both open and laparoscopic surgery for gynaecological cancer.
Methodology This is a retrospective cohort study analysing data from 1084 patients who underwent gynaecological cancer surgery between 2006-2019 in St James Hospital, Dublin, Ireland (Tertiary referal centre). 1018 patients with complete follow up were included in the study.
Patients with previous VTE, history of significant haemorrhage outside of a surgical setting within the last 5 years, familial bleeding diathesis and patients receiving anticoagulant therapy were excluded. Univariate analysis was used to determine the effects of LND and LN metastasis on the rate of VTE 90 days post surgery.
Result(s)*Forty three patients developed VTE in 90 days post-surgery (4.3%). VTE rate was significantly higher following open surgery (5.4%) compared with laparoscopic approach (2.3%) (P<0.02). The total number of para aortic LN retrieved significantly increased the rate of VTE (P<0.008). VTE risk within 90 days was 14.3% in patients with >10 para-aortic LN removed , 5.9% in patients <10 paraaortic LN retrieved, compared with 4.4% who had no paraaortic LN removed. Pelvic LN metastatic status significantly influenced VTE risk. 5.2% of patients <5 LN positive for metastasis had VTE, which increased 4 fold (20%) in patients with > 5 LN positive for metastasis (P<0.042). Lymphovascular space invasion(LVSI) had no effect on VTE risk postoperatively. Overall survival was reduced in patients who developed VTE(P<0.0001).
Conclusion*Gynaecological cancer surgery increases VTE risk. The number of paraaortic LN and pelvic LN metastatic status is associated with increased VTE risk and may be useful in predicting VTE post surgery.
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