Original Article

Extended Venous Thromboembolism Prophylaxis after Robotic Staging for Endometrial Cancer

Authors: Alicia Palmieri, DO, Verda Hicks, MD, Noelle Aikman, MD, Mark Borowsky, MD, Ashley Haggerty, MD, Karim ElSahwi, MD

Abstract

Objectives: Our objectives were to estimate the incidence of venous thromboembolism (VTE) after robotic staging for endometrial cancer and to compare the incidence of VTE in patients who received a single dose of preoperative prophylaxis of enoxaparin with those who received extended postoperative prophylaxis.

Methods: This study is a retrospective chart review of patients who underwent robot-assisted surgical staging for endometrial cancer. Patients were categorized into two groups: preoperative prophylaxis (PP), patients who received a single dose of enoxaparin preoperatively, and extended prophylaxis (EP), patients who received 28 days of enoxaparin postoperatively.

Results: In total, 148 patients were included, with 117 patients in the PP group and 31 patients in the EP group. The overall incidence of VTE within 30 days postoperatively was 0.67%. No significant difference was found between the PP and the EP groups (0.9% and 0%, respectively; P = 1.00). Most patients in the cohort had endometrioid adenocarcinoma (78%) with low-grade disease (70%), although there were a greater number of patients in the PP group with uterine serous carcinoma compared with the EP group (17% vs 10%; P = 0.034). The PP group had higher estimated blood loss (106 vs 81 mL; P = 0.009) and longer operative times (178 vs 151 min; P = 0.028) compared with the EP group. Significantly more patients in the PP group underwent lymph node dissection compared with the EP group (32% vs 7%; P = 0.008).

Conclusions: The incidence of VTE following robot-assisted surgical staging for endometrial cancer in this study was 0.67%. No significant difference was found in VTE incidence between the PP group compared with the EP group. Mechanical prophylaxis plus a single dose of preoperative pharmacologic prophylaxis may suffice for low-risk patients following robotic surgical staging for endometrial cancer.
Posted in: Gynecologic Cancer7

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Pecorelli S. Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium. Int J Gynaecol Obstet Off Organ Int Fed Gynaecol Obstet 2009;105:103–104.
 
2. Walker JL, Piedmonte MR, Spirtos NM, et al; Gynecologic Oncology Group Study LAP2. Laparoscopy compared with laparotomy for comprehensive surgical staging of uterine cancer. J Clin Oncol Off J Am Soc Clin Oncol 2009;27:5331–5336.
 
3. Gaia G, Holloway RW, Santoro L, et al. Robotic-assisted hysterectomy for endometrial cancer compared with traditional laparoscopic and laparotomy approaches: a systematic review. Obstet Gynecol 2010;116:1422–1431.
 
4. Behranwala KA, Williamson RCN. Cancer-associated venous thrombosis in the surgical setting. Ann Surg 2009;249:366–375.
 
5. Agnelli G, Bolis G, Capussotti L, et al. A clinical outcome-based prospective study on venous thromboembolism after cancer surgery. Ann Surg 2006;243:89–95.
 
6. Rauh-Hain JA, Hariton E, Clemmer J, et al. Incidence and effects on mortality of venous thromboembolism in elderly women with endometrial cancer. Obstet Gynecol 2015;125:1362–1370.
 
7. Gould MK, Garcia DA, Wren SM, et al. Prevention of VTE in nonorthopedic surgical patients. Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012;141(2 suppl):e227S–e277S.
 
8. Freeman AH, Barrie A, Lyon L, et al. Venous thromboembolism following minimally invasive surgery among women with endometrial cancer. Gynecol Oncol 2016;142:267–272.
 
9. Sandadi S, Lee S, Walter A, et al. Incidence of venous thromboembolism after minimally invasive surgery in patients with newly diagnosed endometrial cancer. Obstet Gynecol 2012;120:1077–1083.
 
10. Bouchard-Fortier G, Geerts WH, Covens A, et al. Is venous thromboprophylaxis necessary in patients undergoing minimally invasive surgery for a gynecologic malignancy? Gynecol Oncol 2014;134:228–232.
 
11. Graul A, Latif N, Zhang X, et al. Incidence of venous thromboembolism by type of gynecologic malignancy and surgical modality in the National Surgical Quality Improvement Program. Int J Gynecol Cancer Off J Int Gynecol Cancer Soc 2017;27:581–587.
 
12. Nelson G, Bakkum-Gamez J, Kalogera E, et al. Guidelines for perioperative care in gynecologic/oncology: Enhanced Recovery After Surgery (ERAS) Society recommendations-2019 update. Int J Gynecol Cancer Off J Int Gynecol Cancer Soc 2019;29:651–668.
 
13. American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins—Gynecology. Prevention of venous thromboembolism in gynecologic surgery: ACOG Practice Bulletin, number 232. Obstet Gynecol 2021;138:e1–e15.
 
14. Barber EL, Clarke-Pearson DL. Prevention of venous thromboembolism in gynecologic oncology surgery. Gynecol Oncol 2017;144:420–427.
 
15. Bergqvist D, Agnelli G, Cohen AT, et al. Duration of prophylaxis against venous thromboembolism with enoxaparin after surgery for cancer. N Engl J Med 2002;346:975–980.
 
16. Barber EL, Clarke-Pearson DL. The limited utility of currently available venous thromboembolism risk assessment tools in gynecological oncology patients. Am J Obstet Gynecol 2016;215:445.e1–445.e9.
 
17. Barber EL, Gehrig PA, Clarke-Pearson DL. Venous thromboembolism in minimally invasive compared with open hysterectomy for endometrial cancer. Obstet Gynecol 2016;128:121–126.
 
18. Kim JS, Mills KA, Fehniger J, et al. Venous thromboembolism in patients receiving extended pharmacologic prophylaxis after robotic surgery for endometrial cancer. Int J Gynecol Cancer Off J Int Gynecol Cancer Soc 2017;27:1774–1782.
 
19. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004;240:205–213.
 
20. Matsuo K, Yessaian AA, Lin YG, et al. Predictive model of venous thromboembolism in endometrial cancer. Gynecol Oncol 2013;128:544–551.
 
21. Marques de Marino P, Rial Horcajo R, Garcia Grandal T, et al. Thromboprophylaxis in gynecologic cancer surgery: is extended prophylaxis with low molecular weight heparin justified? Eur J Obstet Gynecol Reprod Biol 2018;230:90–95.
 
22. Clarke-Pearson DL, DeLong ER, Synan IS, et al. Variables associated with postoperative deep venous thrombosis: a prospective study of 411 gynecology patients and creation of a prognostic model. Obstet Gynecol 1987;69:146–150.
 
23. Carbajal-Mamani SL, Dideban B, Schweer D, et al. Incidence of venous thromboembolism after robotic-assisted hysterectomy in obese patients with endometrial cancer: do we need extended prophylaxis? J Robot Surg 2021;15:343–348.
 
24. Cain K, Schmeler KM, Langley G, et al. Patient cost associated with filling a prescription for extended-duration venous thromboembolism (VTE) prophylaxis following surgery for gynecologic cancer. Gynecol Oncol 2012;127:18–21.
 
25. Sachdeva A, Dalton M, Lees T. Graduated compression stockings for prevention of deep vein thrombosis. Cochrane Database Syst Rev 2018;11:CD001484.
 
26. Agu O, Hamilton G, Baker D. Graduated compression stockings in the prevention of venous thromboembolism. Br J Surg 2002;86:992–1004.