Clinical Analysis And Prevention Of Venous Thromboembolism After Major Urological Pelvic Oncology Surgery

Objective: Venous thromboembolism(VTE)is one of the most common postoperative complications,the mortality of VTE within 30 days are very high.Prostate cancer and bladder cancer is the major urological pelvic tumors,and the incidence of them are increasing year by year.We aim at collecting the clinical data in our hospital to understand the incidence and influencing factors of VTE after major urological pelvic oncologic surgery(radical cystectomy,radical prostatectomy)and to summarize the experience of the prevention and treatment of perioperative VTE in patients with urological pelvic oncology surgery.Methods: We retrospectively analysed of the clinical data of the patients with radical cystectomy or radical prostatectomy in our hospital from January 2010 to December 2016.To understand the incidence of postoperative VTE and the changes after use of Caprini venous thrombosis model and the corresponding preventive measures.To analyze the effect of the relevant influencing factors on VTE in different patients and surgical procedures.Search the related VTE guidelines and literature to summarize the experience of prevention and treatment of VTE.Results: According to the inclusion criteria and exclusion criteria.A total of 316 patients with prostate tumor or bladder tumor and treated with radical tumor resection surgery.Which contains 180 cases of radical cystectomy,the average age was 68.6±11.6(38-91)years;the mean BMI was 24.0±3.1(19.0-32.1)Kg/m2.And including laparoscopic surgery in 124 cases(68.9%),open surgery in 56 cases(31.1%).the mean operative time was 312.6±97.1(140-600)min;the mean operative bleeding was 592.4±492.8(50-2500)ml;perioperative blood transfusion in 56 cases(31.1%);intraoperative with pelvic lymph nodes dissection in 157 cases(87.2%).And contains 136 cases of radical prostatectomy,mean age 71.0±7.2(52-86)years;mean BMI 25.2±2.8(20.6-34.1)Kg/m2.And including laparoscopic surgery in 110 cases(80.9%),open surgery in 26 cases(19.1%).mean operative time 216.6±76.4(60-420)min;mean surgical bleeding 500.7±636.6(30-4000)ml;perioperative blood transfusion in 23cases(16.9%);intraoperative with pelvic lymph nodes dissection in 57 cases(41.9%).There are 6 cases with symptom and newly diagnosed with VTE in 316 cases within the 30 days after surgery,for an overall incidence of 1.9%.There are 6 cases(1.9%)with deep vein thrombosis and 1 case(0.3%)with pulmonary embolism,1 case with deep vein thrombosis and pulmonary embolism at the same time.VTE occurred at a median of 7.7±5.6(1-16)days postoperatively.The incidence of VTE was 2.2%(4/180)in radical cystectomy,and the incidence of VTE was 1.5%(2/136)in radical prostatectomy.In this study,intraoperative pelvic lymphadenectomy increased the incidence of postoperative VTE,The effect of perioperative blood transfusion,tumor stage,operation time(>4h)on postoperative VTE has no statistically significant difference(P> 0.05).Use the Caprini thrombosis assessment model for perioperative VTE assessment and prophylaxis have reduced the VTE events after surgery(P<0.05,The difference has statistically significant).Conclusion: The incidence of symptomatic VTE within 30 days after major urological pelvic oncology surgery is 1.9%.The incidence of VTE after radical cystectomy is higher than radical prostatectomy(2.2% VS 1.5%),in addition,pelvic lymph node dissection was significantly associated with postoperative VTE.Use the Caprini thrombosis assessment model for perioperative VTE assessment and prophylaxis have been effectively predicted the risk of postoperative risk of VTE and reduced the VTE events after surgery.But the VTE risk Assessment modle and prevention guidelines for urological surgery are still the direction of current research.