Symptomatic and asymptomatic venous thromboembolism after minimally invasive surgery for gynecological cancers

Aims

To clarify the frequency of postoperative symptomatic and asymptomatic venous thromboembolism (VTE) in patients who underwent minimally invasive surgery (MIS) for gynecological cancers; and to identify the risk factors associated with pulmonary embolism (PE).

Methods

We analyzed data for patients with endometrial, cervical, or ovarian cancers who underwent MIS or open surgery between February 2012 and December 2021 at Mie University Hospital, Japan. Patients who required conversion to open surgery were excluded. We treated deep vein thrombosis (DVT), including distal DVT, with preoperative anticoagulation. In all cases, intra- and postoperative VTE prophylaxis with anticoagulation, intermittent pneumatic compression, and compression stockings were provided.

Results

Overall, 382 patients with gynecological cancers who underwent MIS were included. Approximately 90% of patients had stage I disease. Symptomatic and asymptomatic PE occurred in 0.2% and 1.5% of patients who underwent MIS, respectively. All patients who developed PE had DVT. In the MIS group, both DVT and PE occurred in seven cases each (1.8%). Conversely, in the open surgery group (n = 817), there were 19 (2.3%) and 13 (1.6%) cases of DVT and PE, respectively. DVT and PE incidence rates did not significantly differ between the MIS and open surgery groups (DVT: p = 0.67, PE: p = 0.80). Uni- and multivariate analyses revealed that an operative time >6 h was associated with PE (p = 0.034).

Conclusions

VTE incidence was low among patients with gynecological cancers who underwent MIS. VTE rates remained low following open surgery or MIS when appropriate anticoagulation was administered. However, caution should be exercised during prolonged surgeries.