Elevated Thrombin Generation and Venous Thromboembolism Incidence in Patients Undergoing Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy Compared with Minimally Invasive Rectal Surgery

Mikkel Lundbech; Andreas E Krag; Lene H Iversen; Birgitte Brandsborg; Nina Madsen; Anne-Mette Hvas

doi:10.1055/a-2413-4989

Elevated Thrombin Generation and Venous Thromboembolism Incidence in Patients Undergoing Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy Compared with Minimally Invasive Rectal Surgery

Thromb Haemost. 2024 Sep 29. doi: 10.1055/a-2413-4989. Online ahead of print.

Authors

Mikkel Lundbech^{1

2}, Andreas E Krag^{2

3}, Lene H Iversen^{2

4}, Birgitte Brandsborg^{2

5}, Nina Madsen^{2

6}, Anne-Mette Hvas⁷

Affiliations

¹ Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark.
² Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
³ Department of Plastic and Breast Surgery, Aarhus University Hospital, Aarhus, Denmark.
⁴ Department of Surgery, Aarhus University Hospital, Aarhus, Denmark.
⁵ Department of Anesthesiology South, Aarhus University Hospital, Aarhus, Denmark.
⁶ Department of Radiology, Aarhus University Hospital, Aarhus, Denmark.
⁷ Faculty of Health, Aarhus University, Aarhus, Denmark.

PMID: 39260397
DOI: 10.1055/a-2413-4989

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 to 4, and 5 to 7. Systematic ultrasonographic screening for VTE was performed between POD 3 and 7. Computed tomography scan was performed if complications were suspected. The primary endpoint was the difference in mean change (Δ) 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 to 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: Δ1,322 [1,040:1,604] pmol/L, p < 0.01. The VTE incidence was significantly higher after CRS + HIPEC than MIS (24 vs. 5%, p = 0.01).

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.