Facing the challenge of venous thromboembolism prevention in patients undergoing major abdominal surgical procedures for gastrointestinal cancer

doi:10.4251/wjgo.v10.i10.328

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World Journal of Gastrointestinal Oncology

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World J Gastrointest Oncol. Oct 15, 2018; 10(10): 328-335
Published online Oct 15, 2018. doi: 10.4251/wjgo.v10.i10.328

Facing the challenge of venous thromboembolism prevention in patients undergoing major abdominal surgical procedures for gastrointestinal cancer

Aikaterini Mastoraki, Sotiria Mastoraki, Dimitrios Schizas, Raphael Patras, Nikolaos Krinos, Ioannis S Papanikolaou, Andreas Lazaris, Theodore Liakakos, Nikolaos Arkadopoulos

Aikaterini Mastoraki, Raphael Patras, Nikolaos Krinos, Ioannis S Papanikolaou, Nikolaos Arkadopoulos, 4^th Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Athens 12462, Greece

Sotiria Mastoraki, Andreas Lazaris, Department of Vascular Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Athens 12462, Greece

Dimitrios Schizas, Theodore Liakakos, 1^st Department of Surgery, National and Kapodistrian University of Athens, Laikon Hospital, Athens 11527, Greece

Author contributions: All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.

Conflict-of-interest statement: No potential conflicts of interest. No financial support.

Correspondence to: Aikaterini Mastoraki, MD, PhD, Academic Research, Doctor, Lecturer, Surgeon, 4^th Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, 1 Rimini Street, Chaidari, Athens 12462, Greece. dr_kamast@yahoo.gr

Telephone: +30-69-32577710 Fax: +30-21-32061018

Received: June 20, 2018
Peer-review started: June 21, 2018
First decision: July 19, 2018
Revised: August 22, 2018
Accepted: August 28, 2018
Article in press: August 28, 2018
Published online: October 15, 2018
Processing time: 117 Days and 4.8 Hours

Abstract

Venous thromboembolism (VTE) refers to a hypercoagulable state that remains an important and preventable factor in the surgical treatment of malignancies. VTE includes two identical entities with regards to deep vein thrombosis and pulmonary embolism. The incidence of VTE after major abdominal interventions for gastro-intestinal, hepato-biliary and pancreatic neoplastic disorders is as high as 25% without prophylaxis. Prophylactic use of classic or low-molecular-weight heparin, anti-Xa factors, antithrombotic stocking, intermittent pneumatic compression devices and early mobilization have been described. Nevertheless, thromboprophylaxis is often discontinued after discharge, although a serious risk may persist long after the initial triggering event, as the coagulation system remains active for at least 14 d post-operatively. The aim of this review is to evaluate the results of the current practice of VTE prevention in cancer patients undergoing major abdominal surgical operations, with special attention to adequately elucidated guidelines and widely accepted protocols. In addition, the recent literature is presented in order to provide an update on the current concepts concerning the surgical management of the disease.

Keywords: Deep vein thrombosis; Pulmonary embolism; Gastro-intestinal cancer; Thromboprophylaxis; Venous thromboembolism

Core tip: Venous thromboembolism (VTE) refers to a hypercoagulable state that remains an important and preventable factor in the surgical treatment of malignancies. The incidence of VTE after major interventions for gastro-intestinal, hepatobiliary and pancreatic neoplastic disorders is as high as 25% without prophylaxis. Prophylactic use of classic or low-molecular-weight heparin, anti-Xa factors, antithrombotic stocking, intermittent pneumatic compression devices and early mobilization have been described. The aim of this review is to evaluate the results of the current practice of VTE prevention in cancer patients undergoing major abdominal surgical operations, with attention to adequately elucidated guidelines and widely accepted protocols.