SHISA 1601 data

Background Venous thromboembolism (VTE) is a potentially fatal perioperative complication. This study aimed to clarify the frequency and risk factors of intercurrent venous thromboembolism (VTE) in patients undergoing major curative gastric cancer surgery.
Methods This prospective multicenter observational study included patients with gastric cancer who underwent radical gastrectomy at 5 hospitals between June 2016 and May 2018. Patients who were preoperatively administered anticoagulants were excluded.
Results A total of 126 patients were eligible to participate. VTE occurred within 9 days postoperatively in 5 cases (4.0 %; 2 symptomatic and 3 asymptomatic). Postoperative day (POD) 1 plasma D-dimer and soluble fibrin (SF) levels were significantly higher in the VTE group than in the non-VTE group. Receiver operating characteristic curve analysis indicated a statistically significant ability of POD 1 D-dimer and SF levels to predict postoperative VTE development after gastrectomy; this finding was reflected by areas under the curve of 0.97 (95% confidence interval [CI], 0.92–1.0) and 0.87 (95% CI, 0.74–1.0). Cutoff values of D-dimer (24.6 µg/mL) and SF (64.1 µg/mL) were determined. Intraoperative blood transfusion (odds ratio [OR], 7.86), POD 1 D-dimer ≥24.6 µg/mL (OR, 17.35), and POD 1 SF ≥64.1 µg/mL (OR, 19.5) were independent risk factors for postoperative VTE (p < 0.05).
Conclusion VTE occurred in 4.0% patients after gastric cancer surgery; however, with an early diagnosis and anticoagulant therapy, no patients experienced progression. Careful observation of patients with high risk factors for VTE, including intraoperative blood transfusion and high POD 1 D-dimer or SF levels, would contribute to the early detection of VTE.

背景：围术期静脉血栓栓塞症（VTE）是一种可能致命的并发症。本研究旨在阐明接受重大根治性胃癌手术的患者中术后并发静脉血栓栓塞症（VTE）的频率及风险因素。方法：本前瞻性多中心观察性研究纳入了2016年6月至2018年5月在5家医院接受根治性胃切除术的胃癌患者。术前接受抗凝治疗的患者被排除在外。结果：共有126名患者符合参与条件。术后9天内发生VTE 5例（4.0%；其中2例有症状，3例无症状）。术后第1天，VTE组的血浆D-二聚体和可溶性纤维蛋白（SF）水平显著高于非VTE组。接受者操作特征曲线分析表明，术后第1天的D-二聚体和SF水平具有统计学意义的预测能力，以胃切除术后的VTE发展为预测指标，其曲线下面积为0.97（95%置信区间[CI]，0.92–1.0）和0.87（95% CI，0.74–1.0）。确定了D-二聚体的截断值（24.6 µg/mL）和SF的截断值（64.1 µg/mL）。术中输血（优势比[OR]，7.86）、术后第1天D-二聚体≥24.6 µg/mL（OR，17.35）和术后第1天SF≥64.1 µg/mL（OR，19.5）是术后VTE的独立风险因素（p < 0.05）。结论：胃癌手术后，VTE的发生率为4.0%；然而，通过早期诊断和抗凝治疗，无一例患者出现进展。对VTE高风险因素的患者进行细致观察，包括术中输血和术后第1天D-二聚体或SF水平较高，有助于VTE的早期发现。