Risk Factors and Prevention of Perioperative Venous Thromboembolism After Cytoreductive Surgery plus Hyperthermic Intraperitoneal Chemotherapy: An Analysis of 820 Cases

Objective To analyze the independent risk factors for perioperative venous thromboembolism (VTE) after cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy(HIPEC), and to develop an integrated VTE prevention strategy.

Methods The comprehensive database of CRS+HIPEC was first systematically investigated to analyze the risk factors for VTE, and univariate and multivariate analyses were conducted to screen independent risk factors for VTE. An integrated VTE prevention strategy combining physiotherapy and pharmaceutical treatment was developed and applied to the patients.

Results Among the 820 patients treated with CRS+HIPEC in the database, 14(1.7%) patients developed VTE in the perioperative period, including 6(0.7%) patients with asymptomatic VTE events and 8(1.0%) patients with 9 symptomatic events. No VTE-related death occurred. Univariate analysis revealed 5 high risk factors: old age(P=0.043), overweight(P=0.023), previous VTE-history(P=0.001), preoperative VTE(P=0.008) and vascular tumor thrombus(P=0.036). Multivariate analysis confirmed two independent risk factors: previous VTE history(OR=13.744, 95%CI: 2.391-64.455) and vascular tumor thrombus(OR=5.858, 95%CI: 1.028-33.387).

Conclusion Previous VTE history and vascular tumor thrombus are independent risk factors for peritoneal cancer(PC) patients after CRS+HIPEC. Physiotherapy-based integrated prevention and treatment strategy could help prevent VTE.