Comprehensive assessment of 1-year postoperative venous thromboembolism and associated mortality risks in hepatopancreatobiliary cancer surgeries: A national survey

IF 2.7 2区医学 Q1 SURGERY Surgery Pub Date : 2025-05-01 Epub Date: 2025-02-13 DOI:10.1016/j.surg.2025.109171

Jérémie Thereaux MD, PhD , Bogdan Badic MD, PhD , Basil Fuchs MD , Cyril Leven PharmD , Anais Caillard MD , Karin Lacut MD, PhD , Jean-Philippe Metges MD , Francis Couturaud MD, PhD

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Abstract

Background

Venous thromboembolism is a well-recognized complication after hepatopancreatobiliary surgery. However, there is a paucity of nationwide data on risk factors and incidence within 1 year of surgery in patients undergoing hepatopancreatobiliary surgery.

Methods

This nationwide observational population-based cohort study used data extracted from all patients undergoing surgery for cancer surgery of the liver and the pancreas in France between 1 January 2015 and 31 December 2017. Estimation of 1 postoperative year cumulative incidence of venous thromboembolism and Cox proportional hazards model on 1-year global mortality were performed.

Results

During the study period, 16,960 patients underwent cancer surgery of the liver (n = 9,381) or pancreas (n = 7,579). The 90-day postoperative rate of venous thromboembolism was 6.1% (cancer surgery of the liver) and 6.7% (cancer surgery of the pancreas). Main risk factors of 90-day postoperative rate of venous thromboembolism were major hepatectomy (1.85; 1.55–2.21), left pancreatectomy (1.45; 1.18–1.79), presence of obesity (1.41; 1.16–1.71), history of venous thromboembolism (4.58; 3.41–6.14), open approach (1.31; 1.06–1.62), and the occurrence of serious surgical complication (1.55; 1.35–1.79). At 1 year, patients undergoing cancer surgery of the liver were at a lower risk of cumulative incidence (%) of venous thromboembolism compared with the cancer surgery of the pancreas group (P < .001) (7.0; 6.5–7.6 vs 9.8; 9.1–10.4). Patients with venous thromboembolism within 1 year had greater risks of 1-year global mortality for each hepatopancreatobiliary surgery group: 3.58 (95% confidence interval, 3.02–4.23) and 3.97 (95% confidence interval, 3.40–4.63), respectively.

Conclusion

Postoperative venous thromboembolism is a significant issue after hepatopancreatobiliary surgery, within 90 days postoperatively and up to 1 year, with the cancer surgery of the pancreas group being particularly at risk. A greater risk of global mortality within 1 year for patients experiencing early or late venous thromboembolism was found.

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肝、胰、胆管癌手术后1年静脉血栓栓塞及相关死亡风险的综合评估：一项全国性调查

背景：静脉血栓栓塞是肝胆胰手术后公认的并发症。然而，在全国范围内缺乏关于肝胰胆管手术患者术后1年内的危险因素和发病率的数据。方法：这项全国性的基于人群的观察性队列研究使用了2015年1月1日至2017年12月31日在法国接受肝脏和胰腺癌症手术的所有患者的数据。对术后1年静脉血栓栓塞累积发生率和1年全球死亡率的Cox比例风险模型进行估计。结果在研究期间，16,960例患者接受了肝脏（n = 9,381）或胰腺（n = 7,579）的癌症手术。术后90天静脉血栓栓塞率为6.1%（肝癌手术）和6.7%（胰腺癌手术）。术后90天静脉血栓栓塞率的主要危险因素为肝大部切除术(1.85；1.55-2.21)，左胰切除术(1.45；1.18-1.79)，存在肥胖(1.41；1.16-1.71)，静脉血栓栓塞史(4.58；3.41-6.14)，开放方法(1.31；1.06-1.62)，严重手术并发症发生率(1.55；1.35 - -1.79)。1年时，接受肝脏肿瘤手术的患者静脉血栓栓塞的累积发生率（%）低于接受胰腺肿瘤手术的患者(P <；措施)(7.0;6.5-7.6 vs 9.8；9.1 - -10.4)。各肝胆胰手术组1年内静脉血栓栓塞患者1年总体死亡率风险更高：分别为3.58（95%可信区间3.02-4.23）和3.97（95%可信区间3.40-4.63）。结论术后静脉血栓栓塞是肝胆胰手术后的一个重要问题，在术后90天内甚至长达1年，胰腺组的肿瘤手术尤其危险。研究发现，早期或晚期静脉血栓栓塞患者1年内全球死亡风险更高。

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来源期刊

Surgery 医学-外科

CiteScore

5.40

自引率

5.30%

发文量

687

审稿时长

64 days

期刊介绍： For 66 years, Surgery has published practical, authoritative information about procedures, clinical advances, and major trends shaping general surgery. Each issue features original scientific contributions and clinical reports. Peer-reviewed articles cover topics in oncology, trauma, gastrointestinal, vascular, and transplantation surgery. The journal also publishes papers from the meetings of its sponsoring societies, the Society of University Surgeons, the Central Surgical Association, and the American Association of Endocrine Surgeons.