From early risk to one-year mortality: a comprehensive assessment of postoperative venous thromboembolism in upper gastrointestinal cancer patients - a nationwide cohort study

Abstract

Background: Venous thromboembolism (VTE) is a well-recognized complication following gastrointestinal cancer surgery, particularly early postoperatively. The incidence and risk factors of VTE within one year after esophageal (including esophago-gastric junction) (ECS) and gastric (GCS) cancer surgeries, and especially its impact on one-year global mortality, are yet under-explored. Methods: This nationwide observational population-based cohort study used data extracted from all patients undergoing ECS and GCS in France between 1 January 2015 and 31 December 2017. Multivariate logistic regression was used to identify risk factors for 90 post-operative days (POD) VTE (OR 95% CI). Cox proportional hazards models investigated the impact of one-year postoperative VTE on one-year global mortality (HR (95% CI)). Results: During the study period, 8,005 patients underwent ECS (N=3,429) or GCS (N=4,576) (31.8% female; 66.7±12.1 years old). Majority (N=4,951) of patients had preoperative treatment (Chemotherapy or radiochemotherapy). Ninety POD incidence of VTE were 4.7% (ECS=6.2%) (GCS=3.6%) (44.7% during first hospitalization, 19.0% needing readmission and 36.3% ambulatory management). Main risk factors were 3 and 2 field esophagectomy (3.6 (2.20-5.83) and 2.2 (1.68-3.0)), obesity (1.9 (1.40-2.58)) and history of VTE (5.1 (2.72-9.45)). Late-onset VTE rates (occurring between the 6th and 12th month) represented 1.80% and 1.46% of the overall ECS and GCS groups. Patients with VTE within one year had higher risks of one-year global mortality: 2.04 1.52; 2.73) and 2.71 (2.09; 3.51), respectively. Conclusion: Our extensive analysis of a nationwide database highlights the significant risk of postoperative VTE after ECS and GCS, persisting within 90 POD and up to one year. Crucially, a higher risk of global mortality within one year for patients experiencing early or late VTE was found. These findings could advocate for further research into extended prophylactic regimens, particularly for those most at risk.