P71: Are Pathologic Factors Associated with Higher Risk for Venous Thromboembolism After Gastrointestinal Cancer Surgery? A Potential Opportunity to Tailor Prophylaxis

Thursday, March 23, 2023

3:31 PM – 3:36 PM

Location: SSO HUB: Rare/Metastatic Cancers Zone

Poster Presenter(s)

Lauren M. Janczewski, MD

Postdoctoral Research Fellow
Northwestern University Feinberg School of Medicine, United States

Disclosure information not submitted.

Author(s)

Lauren M. Janczewski, MD

Postdoctoral Research Fellow
Northwestern University Feinberg School of Medicine, United States

Disclosure information not submitted.
Casey Silver, MD

Research Fellow
Northwestern University
Chicago, Illinois, United States

Disclosure information not submitted.
CS

Cary Jo R. Schlick, MD, MS

Surgical Oncology Fellow
Memorial Sloan Kettering Cancer Center, United States

Disclosure information not submitted.
DO

David D. Odell, MD, MS

Associate Professor of Surgery
Northwestern University Feinberg School of Medicine, United States

Disclosure information not submitted.
DB

David J. Bentrem, MD, MS

Professor of Surgery
Northwestern University Feinberg School of Medicine, United States

Disclosure information not submitted.
AY

Anthony D. Yang, MD, MS

Associate Professor of Surgery
Indiana University School of Medicine, United States

Disclosure information not submitted.
KB

Karl Y. Bilimoria, MD, MS

Chair of Surgery
Indiana University School of Medicine, United States

Disclosure information not submitted.
Ryan Merkow, MD, MS (he/him/his)

Assistant Professor of Surgery
Northwestern University
Chicago, Illinois, United States

Disclosure information not submitted.

Introduction: Inpatient and extended outpatient chemoprophylaxis are the standard of care following gastrointestinal (GI) cancer surgery to decrease the risk of venous thromboembolism (VTE). However, variation in VTE risk based on pathologic factors (e.g., stage, histology) is unclear. Our objective was to evaluate the association of pathologic factors with VTE following GI cancer surgery.

Methods: The American College of Surgeons National Surgical Quality Improvement Program procedure targeted datasets were queried for patients who underwent colorectal, pancreatic, primary hepatic, and esophageal cancer surgery from 2017-2020. Postoperative 30-day VTE requiring anticoagulation was assessed. Disease specific and pathologic factors associated with VTE were evaluated using multivariable logistic regression.

Results: A total of 66,124 patients underwent colorectal (n=47,022), pancreatic (n=16,253), hepatic (n=4,824), and esophageal (n=2,849) cancer surgery. The incidence of 30-day VTE was highest after pancreatic cancer surgery at 3.3%, followed by 3.2% after esophageal, 2.7% after hepatic and 1.3% after colorectal cancer surgery. T-stage was associated with VTE for pancreatic (all T-stages vs. T1, p< 0.05), hepatic (T4 vs. T1, OR 2.77 95% CI 1.53-5.01) and colorectal (T4 vs. T1, OR 1.78, 95% CI 1.23-2.59) cancer. N-stage was associated with VTE for pancreatic (N2 vs. N0, OR 1.34, 95% CI 1.00-1.79) and colorectal (N2 vs. N0, OR 1.32, 95% CI 1.04-1.68) cancer. M-stage was significantly associated with VTE for esophageal (OR 2.54, 95% CI 1.24-5.19) and colorectal (OR 1.47, 95% CI 1.17-1.85) cancer. Histologic subtype did not influence VTE rates, with the exception of pancreatic neuroendocrine tumors (OR 1.31, 95% CI 1.00-1.71; vs. pancreatic adenocarcinoma). Treatment with neoadjuvant chemoradiation was not associated with VTE after cancer surgery for any malignancy assessed.

Conclusions: More advanced pathologic factors were associated with an increased risk of VTE following GI cancer surgery. Surgeons should be aware that higher stage patients are more likely to experience VTE in the 30-day postoperative period and adherence to chemoprophylaxis guidelines remains important to minimize the risk of this potentially preventable event. A tailored approach to VTE chemoprophylaxis prescribing practices which incorporates pathologic factors could be considered.

Learning Objectives:

Upon completion, participants will be able to evaluate the risk of postoperative venous thromboembolism between different gastrointestinal cancers.
Upon completion, participants will be able to assess the association of pathologic factors with venous thromboembolism following gastrointestinal cancer surgery.
Upon completion, participants will be able to consider a tailored approach to chemoprophylaxis based on disease type and individualized pathologic factors.