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Open Access
CC BY 4.0 · TH Open 2022; 06(03): e168-e176
DOI: 10.1055/s-0042-1750378
Original Article

Venous Thromboembolism in Surgically Treated Esophageal Cancer Patients: A Provincial Population-Based Study

Gileh-Gol Akhtar-Danesh
1   Department of Surgery, McMaster University, Hamilton, Ontario, Canada
,
Noori Akhtar-Danesh
2   School of Nursing, McMaster University, Hamilton, Ontario, Canada
3   Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
,
Yaron Shargall
1   Department of Surgery, McMaster University, Hamilton, Ontario, Canada
4   Division of Thoracic Surgery, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
› Author Affiliations
Funding None.
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Abstract

Objective Venous thromboembolism (VTE) is a major cause of morbidity and mortality in surgical patients. Surgery for esophageal cancer carries a high risk of VTE. This study identifies the risk factors and associated mortality of thrombotic complications among patients undergoing esophageal cancer surgery.

Methods All patients in the province of Ontario undergoing esophageal cancer surgery from 2007 to 2017 were identified. Logistic regression identified VTE risk factors at 90 days and 1 year postoperatively. A flexible parametric survival analysis compared mortality and survival up to 5 years after surgery for patients with and without a postoperative VTE.

Results Overall 9,876 patients with esophageal cancer were identified; 2,536 (25.7%) underwent surgery. VTE incidence at 90 days and 1 year postoperatively were 4.1 and 6.3%, respectively. Patient factors including age, sex, performance status, and comorbidities were not associated with VTE risk. VTE risk peaked at 1 month after surgery, with a subsequent decline, plateauing after 6 months. Adenocarcinoma was strongly associated with VTE risk compared with squamous cell carcinoma (SCC) (odds ratio [OR] 2.53, 95% confidence interval [CI] 1.38–4.63, p = 0.003). VTE risk decreased with adjuvant chemotherapy (OR = 0.58, 95% CI 0.36–0.94, p = 0.028). Postoperative VTE was associated with decreased survival at 1 and 5 years (hazard ratio = 1.57, 95% CI 1.23–2.00, p < 0.001).

Conclusion Esophageal cancer patients with postoperative VTE have worse long-term survival compared with those without thrombotic complications. Adenocarcinoma carries a higher VTE risk compared with SCC. Strategies to reduce VTE risk should be considered to reduce the negative impacts on survival conferred by thrombotic events.

Keywords

esophageal cancer - extended prophylaxis - venous thromboembolism - long-term survival

Ethics Approval

The Hamilton Integrated Research Ethics Board (HiREB) provided approval for this study in August 2019, approval number 7771-C.




Publication History

Received: 11 January 2022

Accepted: 29 April 2022

Article published online:
11 July 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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