PDF icon Download PDF
Thromb Haemost 2025; 125(05): 460-469
DOI: 10.1055/a-2413-4989
Coagulation and Fibrinolysis

Elevated Thrombin Generation and Venous Thromboembolism Incidence in Patients Undergoing Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy Compared with Minimally Invasive Rectal Surgery

Mikkel Lundbech
1   Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
2   Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
,
Andreas E. Krag
2   Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
3   Department of Plastic and Breast Surgery, Aarhus University Hospital, Aarhus, Denmark
,
Lene H. Iversen
2   Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
4   Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
,
Birgitte Brandsborg
2   Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
5   Department of Anesthesiology South, Aarhus University Hospital, Aarhus, Denmark
,
Nina Madsen
2   Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
6   Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
,
Anne-Mette Hvas
7   Faculty of Health, Aarhus University, Aarhus, Denmark
› Author Affiliations
› Further Information
   Permissions and Reprints


Preview

Abstract

Introduction

Surgical treatment of colorectal cancer carries a risk for venous thromboembolism (VTE). We investigated changes in coagulation and fibrinolysis and the VTE incidence within 30 days in patients undergoing open cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS + HIPEC) for peritoneal metastases from colorectal cancer and minimally invasive surgery (MIS) for localized rectal cancer.

Methods

This cohort study included 45 CRS + HIPEC and 45 MIS patients. Blood samples were obtained preoperatively, at the end of surgery, and postoperative day (POD) 1, 3 to 4, and 5 to 7. Systematic ultrasonographic screening for VTE was performed between POD 3 and 7. Computed tomography scan was performed if complications were suspected. The primary endpoint was the difference in mean change (Δ) with [95% confidence intervals] from preoperative to end of surgery in prothrombin fragment 1 + 2 (F1 + 2) levels. Secondary endpoints were the difference in mean change in biomarkers of coagulation and fibrinolysis from preoperative to POD 5 to 7 and the VTE incidence.

Results

F1 + 2 levels increased from preoperative to the end of surgery in both groups. The mean increase from preoperative to end of surgery in F1 + 2 levels was significantly greater in CRS + HIPEC patients than MIS patients: Δ1,322 [1,040:1,604] pmol/L, p < 0.01. The VTE incidence was significantly higher after CRS + HIPEC than MIS (24 vs. 5%, p = 0.01).

Conclusion

F1 + 2 levels were increased after both procedures, but to a far greater extent following CRS + HIPEC. The VTE incidence within 30 days was significantly higher in patients treated with CRS + HIPEC than in MIS patients.

Keywords

blood coagulation - coagulation - hyperthermic intraperitoneal chemotherapy - neoplasms - surgical procedures - operative - cytoreductive surgery - minimally invasive surgical procedures

Supplementary Material



Publication History

Received: 15 April 2024

Accepted: 02 September 2024

Accepted Manuscript online:
11 September 2024

Article published online:
29 September 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany