Elevated thrombin generation and VTE incidence in patients undergoing cytoreductive surgery with HIPEC compared with minimally invasive rectal surgery.

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, 3-4, and 5-7. Systematic ultrasonographic screening for VTE was performed between POD 3-7. Computed tomography scan was performed if complications were suspected. The primary endpoint was the difference in mean change ( 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 5-7, 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: 1322 [1040:1604] pmol/l, P = 0.001. The VTE incidence was significantly higher after CRS+HIPEC than MIS (24% vs. 5%, P = 0.012). 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.