Early mobilization combined with intermittent pneumatic compression for deep vein thrombosis prevention after hepatocellular carcinoma surgery

doi:10.4240/wjgs.117081

Advanced Search

BPG is committed to discovery and dissemination of knowledge

Home / Archive / Volume 18, Issue 6

This Article

(1)

(0)

(1)

Peer-Review Report of This Article

CrossCheck and Google Search of This Article

Academic Rules and Norms of This Article

Citation of this article

Corresponding Author of This Article

Research Domain of This Article

Article-Type of This Article

Open-Access Policy of This Article

Times Cited Counts in Google of This Article

Journal Information of This Article

Publication Name

World Journal of Gastrointestinal Surgery

ISSN

1948-9366

Publisher of This Article

Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

- Full Article (XML)

Retrospective Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastrointest Surg. Jun 27, 2026; 18(6): 117081
Published online Jun 27, 2026. doi: 10.4240/wjgs.117081

Early mobilization combined with intermittent pneumatic compression for deep vein thrombosis prevention after hepatocellular carcinoma surgery

Xiao-Jie Liang, Jin-Ling Dong, Qin-Xue Zhou

Xiao-Jie Liang, Jin-Ling Dong, Department of Infectious Diseases, First Affiliated Hospital of Huzhou University (The First People’s Hospital of Huzhou), Huzhou 313000, Zhejiang Province, China

Qin-Xue Zhou, Department of Nursing, First Affiliated Hospital of Huzhou University (The First People’s Hospital of Huzhou), Huzhou 313000, Zhejiang Province, China

Author contributions: Liang XJ was responsible for study design, data analysis, and manuscript writing; Dong JL was responsible for clinical management of patients, data collection, and manuscript review; Zhou QX was responsible for implementation of early mobilization and intermittent pneumatic compression therapy, nursing team coordination, and data quality control. All authors read and approved the final manuscript.

AI contribution statement: We used Grammarly for language polishing and DeepL for translation of certain non-critical sentences during the early drafting stage. No AI tool was used for scientific writing, content generation, or intellectual input. All sections of the main text were originally written by the authors. AI tools were not used to generate any scientific content, including hypotheses, experimental design, data interpretation, or conclusions. No AI tool was used for data analysis or substantive writing assistance. The study design, methodology, data analysis, and interpretation of results were performed solely by the authors. All figures, graphs, and images were created by the authors using standard scientific software (e.g., GraphPad Prism, SPSS, or similar), or were original experimental data.

Supported by Huzhou Science and Technology Bureau Public Welfare Applied Research Project (Medical and Health General Project), No. 2021GY19.

Institutional review board statement: This study was reviewed and approved by the Medical Research and Clinical Trial Ethics Committee of Huzhou First People’s Hospital (The First Affiliated Hospital of Huzhou University), approval No. 2022KYLL028.

Informed consent statement: The requirement for written informed consent was waived by the Medical Research and Clinical Trial Ethics Committee of Huzhou First People’s Hospital because this was a retrospective study using previously collected clinical data, with no patient identifiers and no additional risk to participants.

Conflict-of-interest statement: The authors declare that they have no conflict of interest.

Data sharing statement: The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.

Corresponding author: Qin-Xue Zhou, Department of Nursing, First Affiliated Hospital of Huzhou University (The First People’s Hospital of Huzhou), No. 158 Guangchanghou Road, Huzhou 313000, Zhejiang Province, China. zhouqinxue2025@163.com

Received: January 6, 2026
Revised: February 1, 2026
Accepted: March 10, 2026
Published online: June 27, 2026
Processing time: 159 Days and 9.1 Hours

Abstract

BACKGROUND

Hepatocellular carcinoma (HCC) remains a common malignancy, with surgical intervention being the main curative treatment. Postoperative deep vein thrombosis (DVT) incidence after HCC surgery is significantly high due to major surgical trauma, prolonged bed rest, and patient-specific risk factors such as cirrhosis and coagulation dysfunction. Current DVT prevention strategies, including pharmacological and physical prophylaxis, have reduced effectiveness when used separately. Early mobilization and intermittent pneumatic compression (IPC) have shown potential benefits, but evidence on their combinations remains unclear.

AIM

To investigate the efficacy and safety of early mobilization combined with IPC for lower extremity DVT prevention after HCC surgery.

METHODS

A retrospective analysis was conducted on 100 patients who underwent HCC surgery at our hospital from January 2020 to June 2025. Forty-eight patients who received standard care from January 2020 to June 2022 were assigned to the control group, and 52 patients who received early mobilization combined with IPC from July 2022 to June 2025 were assigned to the observation group. The observation group initiated a progressive early mobilization protocol 6-8 hours postoperatively, simultaneously applying IPC (pressure 40-60 mmHg, 30-45 minutes per session, twice daily, continued until postoperative day 7). The primary outcome was the incidence of lower extremity DVT. Secondary outcomes included pulmonary embolism (PE) incidence, coagulation parameters (D-dimer, fibrinogen, prothrombin time, activated partial thromboplastin time), lower limb circumference changes, and functional recovery indicators [Barthel Index (BI), Karnofsky Performance Status (KPS) score, independent walking distance].

RESULTS

The total incidence of lower extremity DVT was 5.8% in the observation group, lower than 18.8% in the control group (P = 0.045). D-dimer levels at postoperative days 7 and 14 were lower in the observation group compared to the control group (P = 0.002, P = 0.001). Calf circumference at postoperative day 7 was smaller in the observation group than the control group (P = 0.006). The observation group had earlier time to first ambulation than the control group (P < 0.001); BI scores, KPS scores, and independent walking distance at postoperative days 7 and 14 were all superior in the observation group compared to the control group (P < 0.001). There were no statistically significant differences in PE incidence or pain scores during activity between the two groups (P > 0.05).

CONCLUSION

This study demonstrated the safety and feasibility of implementing a combined early mobilization and IPC strategy to improve recovery for HCC surgery patients. The combined approach indicated reduced lower extremity DVT incidence, improved functional recovery, and good safety profile. Further prospective randomized controlled trials are needed to establish definitive efficacy and optimize protocol parameters.

Keywords: Hepatocellular carcinoma; Postoperative complications; Venous thrombosis; Early mobilization; Intermittent pneumatic compression; Prevention

Core Tip: Early mobilization and intermittent pneumatic compression (IPC) are two effective physical strategies for preventing postoperative deep vein thrombosis (DVT). However, their combined application in hepatocellular carcinoma (HCC) surgery has rarely been investigated. This retrospective study demonstrated that early mobilization combined with IPC significantly reduced postoperative DVT incidence, decreased D-dimer levels, improved limb function, and accelerated recovery without increasing adverse events. The findings suggest that this combined protocol is a safe, feasible, and enhanced recovery after surgery-based strategy for DVT prevention after HCC surgery.