Is Venous Thromboprophylaxis Necessary in Patients Undergoing Minimally Invasive Surgery for a Gynecologic Malignancy?

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The aim of this retrospective cohort study was to determine the 30-day prevalence rate of symptomatic venous thromboembolism (VTE) among gynecologic cancer patients after minimally invasive surgery (MIS) gynecologic oncology procedures in the absence of anticoagulant thromboprophylaxis. All participants underwent laparoscopic surgery for endometrial, cervical, or ovarian cancer at a single tertiary-care academic center between 2006 and 2013. Data were collected on patient demographics, postoperative diagnosis, medical comorbidities, and perioperative data (including use of thromboprophylaxis). Postoperative data were reviewed to identify clinically evident VTE diagnosed within 30 days of surgery.

Four hundred nineteen patients underwent MIS for gynecologic cancer. Of these, 352 (84%) received no VTE prophylaxis, and 399 (95.2%) had at least a total laparoscopic hysterectomy (simple or radical) or a pelvic lymph node dissection.

Median length of surgery was 137 minutes, and 95% of patients were discharged the day of surgery or the following day. The rate of VTE within 30 days of surgery was 0.57% (2/352); 1 case had pulmonary embolism, and the other deep vein thrombosis. Venous thromboembolism was not diagnosed within 30 days of surgery in any of the 67 patients who received thromboprophylaxis.

The rate of VTE in patients undergoing MIS for a gynecologic malignancy is very low despite the absence of VTE prophylaxis. The routine use of VTE prophylaxis in this population does not appear to be beneficial. Large prospective studies are needed to confirm these findings.

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