Post-Cystectomy VTE Common, Risky

Patients with venous thromboembolism tended to die earlier from their bladder cancer.
Patients with venous thromboembolism tended to die earlier from their bladder cancer.

Venous thromboembolism (VTE) frequently occurs after radical cystectomy (RC), a new study confirms. More than half of VTEs in RC patients occur after hospital discharge.

D. Robert Siemens, MD, and colleagues from Queen's University in Ontario, Canada, used the Ontario Cancer Registry to identify 3,879 patients from the Ontario general population who underwent RC during 1994–2008. VTE occurred in 3.6% of patients within a month of their surgery, according to an analysis of hospital diagnostic codes. That rate rose to 4.7% at 2 months and 5.4% at 3 months.

In agreement with previous research, results published online ahead of print in BJU International showed that patients who experienced VTE had worse cancer specific survival by 35% and overall survival by 27%.

Multivariate analysis revealed no obvious predictive factors for VTE other than longer length of stay in the hospital. VTE also was associated with higher surgeon volume, but that may reflect complex cases or usage of academic centers. The type of urinary diversion with RC possibly plays a role, but the researchers were unable to assess it.

“Although the findings in this population-based study confirmed some previous understanding of the frequency of VTE for this complex surgery, we were surprised at the number that were diagnosed after hospital discharge,” Dr. Siemens said in a press release. “Furthermore, we were unable to identify strong predictive factors associated with VTE, suggesting to us that most all patients should receive prolonged VTE prophylaxis well beyond their hospital discharge.” Until RC research reveals the optimal duration of VTE prophylaxis, the investigators recommend following guidelines for other major pelvic surgery.

Remarkably, VTE was not linked with pathologic stage as assessed by lymph node count, an inexact marker of the extent of pelvic lymph node dissection. The findings also did not support a significant additional risk from adjuvant chemotherapy. Perioperative VTE might be a marker of more aggressive disease, the investigators suggested, warranting further research.

Sources

  1. Doiron RC, Booth CM, Wei X, and Siemens DR. Risk Factors and Timing of Venous Thromboembolism After Radical Cystectomy in Routine Clinical Practice. BJUI. doi: 10.1111/bju.13443.
  2. Blood Clots Pose Major Risks for Patients Undergoing Bladder Cancer Surgery [press release]. Wiley; March 7, 2016.
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