Risk and incidence of perioperative deep vein thrombosis in patients undergoing gastric cancer surgery
Background and purpose
Venous thromboembolism (VTE) is a potentially fatal perioperative complication. Understanding the risk factors for deep vein thrombosis (DVT) and initiating appropriate prophylaxis is pivotal for reducing the risk of VTE. The purpose of this study was to clarify the perioperative risk factors for DVT in patients undergoing surgery for gastric cancer.
We reviewed the findings of lower limb ultrasonography performed in 160 patients who underwent gastrectomy for gastric cancer.
The preoperative and postoperative incidence of DVT was 4.4% (7/160) and 7.2% (11/153), respectively. All postoperative DVTs were of the distal type, whereas preoperative DVTs were of the proximal (n = 3) and distal type (n = 4). None of the patients suffered symptomatic VTE. Multivariate analysis indicated that depth of invasion and D-dimer concentration were independent risk factors for preoperative DVT and that gender and performance status were risk factors for postoperative DVT. Receiver operating characteristic analysis revealed that the optimal cut-off D-dimer concentration was 1.4 μg/mL.
The incidence of perioperative DVT was low for patients undergoing gastric cancer surgery. Therefore, the risk-stratified application of perioperative pharmacologic thromboprophylaxis is thought to be more appropriate than routine pharmacologic thromboprophylaxis for Japanese patients undergoing surgery for gastric cancer.
KeywordsDeep vein thrombosis Gastric cancer Thromboprophylaxis
Compliance with ethical standards
Conflict of interest
The authors have no conflicting financial interests.
- 14.Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA: Cancer J Clin. 2011;61:69–90.Google Scholar
- 15.Tanizawa Y, Bando E, Kawamura T, Tokunaga M, Makuuchi R, Iida K et al. Prevalence of deep venous thrombosis detected by ultrasonography before surgery in patients with gastric cancer: a retrospective study of 1140 consecutive patients. Gastric cancer: official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association; 2016.Google Scholar
- 19.Larsen AC, Frokjaer JB, Fisker RV, Iyer V, Mortensen PB, Yilmaz MK, et al. Treatment-related frequency of venous thrombosis in lower esophageal, gastro-esophageal and gastric cancer—a clinical prospective study of outcome and prognostic factors. Thromb Res. 2015;135:802–8.CrossRefPubMedGoogle Scholar
- 20.Kim JW, Chun EJ, Choi SI, Park DJ, Kim HH, Bang SM, et al. A prospective study on the incidence of postoperative venous thromboembolism in Korean gastric cancer patients: an inquiry into the application of Western guidelines to Asian cancer patients. PLoS One. 2013;8:e61968.CrossRefPubMedPubMedCentralGoogle Scholar
- 21.Barco S, Corti M, Trinchero A, Picchi C, Ambaglio C, Konstantinides SV, et al. Survival and recurrent venous thromboembolism in patients with first proximal or isolated distal deep vein thrombosis and no pulmonary embolism. Journal of thrombosis and haemostasis: JTH; 2017.Google Scholar
- 29.van der Graaf F, van den Borne H, van der Kolk M, de Wild PJ, Janssen GW, van Uum SH. Exclusion of deep venous thrombosis with D-dimer testing-comparison of 13 D-dimer methods in 99 outpatients suspected of deep venous thrombosis using venography as reference standard. Thromb Haemost. 2000;83:191–8.CrossRefPubMedGoogle Scholar
- 30.Wada T, Fujiwara H, Morita S, Fukagawa T, Katai H. Incidence of and risk factors for preoperative deep venous thrombosis in patients undergoing gastric cancer surgery. Gastric cancer: official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association 2017.Google Scholar
- 37.Kuroiwa M, Morimatsu H, Tsuzaki K, Irita K, Sanuki M, Nakatsuka H, et al. Changes in the incidence, case fatality rate, and characteristics of symptomatic perioperative pulmonary thromboembolism in Japan: results of the 2002–2011 Japanese Society of Anesthesiologists Perioperative Pulmonary Thromboembolism (JSA-PTE) Study. J Anesth. 2015;29:433–41.CrossRefPubMedGoogle Scholar