Clinical Study On The Calf Muscular Vein Thrombosis After Surgery Of Breast Cancer

Backgrounds:Calf muscle vein thrombosis (CMVT) is a common postoperative complication of breast cancer. The clinical symptoms are not obvious. A patient presenting with CMVT may feel pain and/or discomfort in the calf, which can be slight. Physical examination may show a swelling calf and relevant Homans’sign (+). These thrombi of calf muscle veins can be transloacated to the proximal veins if untreated, often leading to deep vein thrombosis (DVT). If these thrombi fall off, they may lead to pulmonary embolism (PE). PE is one of the most serious postoperative complications and the second-most common cause of death in patients after surgery of breast cancer, second only to the cancer itself. CMVT not only prolongs their hospitalization, and its treatment is resource-intensive and costly.It is generally accepted that most lower extremity DVT starts in the calf veins and then propagate to proximal veins. Numberous studies found that postoperative DVT is a multifactor disease. However, the incidence and risk factors of CMVT in patients undergoing mastectomy have not been well characterized. The risk factors of postoperative VTE in breast cancer patients, may include elder age, postmenopausal, obesity, comorbidity, advanced breast cancer, peripherally inserted central catheter(PICC), methods of surgery, prolonged operative time and antitumor treatment like chemotherapy, tamoxifen, radiotherapy, trauma, travelling, varicosity and so on. Objective:1.In order to explore the incidence of CMVT in breast cancer patients after mastectomy, we analyzed the medical records of the in-patients who have received surgical treatment in the Breast Department of Qilu hospital;2. Underlying risk factors associated with CMVT, we may be able to take measures to reduce the incidence and prevent the life-threatening PE.Methods:1108patients were collected between Between1January2012and30November2013. They were diagnosed and treated at the department of Breast Surgery, Qilu hospital of Shandong University. In the cohort,39symptomatic inpatients who were suspected of VTE after surgery were examined by Doppler ultrasound(DUS). Among these cases,109patients were excluded because of uncomplete information including4patients with CMVT. A detailed study on history, clinical manifestations, progress notes and pathological results were made, the information of age, BMI, gender, postmenopausal or premenopausal, comobidities, laboratory test results, surgery approach, operation time and clinical stage of breast cancer were acquired.All the data was managed by Microsoft Office Excel2007and analyzed by IBM SPSS Statistics19.Results:The general clinical characteristics of the patients such as age≥45(OR=9.746, P=9.746), hypertension (OR=2.812, P=2.812) and coronary heart disease (OR=4.037, P=4.037) were risk factors for breast cancer associated postoperative CMVT. Other clinical features, such as gender, menopause, obesity, diabetes mellitus, history of surgery under general anesthesia within one month, clinical stage of breast cancer, application of anticoagulant drugs not for postoperative CMVT and duration of surgery were no statistical significant (P>0.05). Results revealed that the value of APTT was shorten compared between postoperative CMVT group and controlgroup. The risk of postoperative CMVT increased in those breast cancer patients whose APTT<30.85s. The rest results of the blood coagulation function index (PT, INR, Fib, TT, DDi), blood fat index (TG and cholesterol) and blood routine (PLT and WBC) were not significant between these two groups (P>0.05). The preoperative treatment of anticancer therapy for breast cancer(preoperative chemotherapy, endocrine therapy), receiving PICC of upper extremity, or the duration of operation was not statistical significant (P>0.05). Of the risk factors included in this study, elder age, hypertension, coronary heart disease(CHD), low APTT were statistically significant (P<0.05) for CMVT. They were included in the multivariable logistic regression analysis to derive adjusted risk of VTE in this population of mastectomy patients. After adjusting for other risk factors, we found that the independent risk factors for breast cancer postoperative CMVT are age≥45(AOR:5.45) and APTT<30.85s (AOR:4.010). Hypertension and CHD in the multivariate logistic regression analysis have no statistical significant (P>0.05).Conclusion:1. Elder age and low APTT are the independent risk factors for postoperative CMVT in breast cancer. Middle-aged patients and elderly patients were more likely to have CMVT than young patients.2. Patients with low APTT (APTT<30.85s) were inclined to have postoperative CMVT than other patients.3. Patients with hypertension and/or CHD have higher risk for postoperative CMVT than others. Nevertheless, this study concluded that hypertension and CHD were not independent risk factors for postoperative CMVT of breast cancer.