Risk Factors for Venous Thromboembolic (VTE) Events in Colorectal Surgery

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Scientific Poster Presentations: 2016 Clinical Congress

interestingly, this phenomenon is countered by and improved rescue rate and lower mortality. Risk Factors for Venous Thromboembolic (VTE) Events in Colorectal Surgery Elizabeth A Bailey, MD, Robyn B Broach, Najjia N Mahmoud, MD, FACS, FASCRS, Emily C Paulson, MD University of Pennsylvania, Philadelphia, PA INTRODUCTION: Risks of deep venous thrombosis (DVT) and pulmonary embolism (PE) after colorectal surgery (CRS) are well-described. The contribution of individual diagnoses and procedures and the rate of portal vein thrombosis (PVT) are less well-characterized. This study aims to identify rates and risk factors for VTE events including PVT after CRS. METHODS: A single-center retrospective cohort study of 2,747 CRS patients (2008-2014) identified patients with new DVT, PE, or PVT within 90 days of surgery. Descriptive statistics and multivariable logistic regression were performed. RESULTS: Seventy-two patients (2.7%) experienced a new VTE (1.2% PVT, 1.5% DVT/PE). Notably, in patients with IBD, PVT occurred in 3.5% and DVT/PE in 1.5%. In patients with malignancy, PVT occurred in 0.6% and DVT/PE in 1.9%. After multivariable adjustment, procedure type and diagnosis remained independent predictors of any VTE. Patients undergoing J pouch reconstruction (OR 2.7, p¼0.029) or total colectomy (OR 2.4, p¼0.026) were at increased risk compared to patients undergoing segmental colectomy. Odds of VTE were also significantly increased for patients with IBD (OR 3.62, p¼0.038) and malignancy (OR 2.61, p¼0.010) compared to diverticulitis. Adjusted predicted probabilities of VTE were calculated revealing a wide range for both any VTE and PVT alone (Table).

Table. Adjusted Predicted 90-day VTE Rate (%)

Variable

Any VTE (DVT, PE, and PVT) Malignancy IBD Diverticulitis

Segmental colectomy

2.1

2.9

0.82

Total colectomy

4.9

6.6

1.9

Proctectomy

2.9

4.0

1.1

J pouch

5.5

7.4 PVT only IBD Diverticulitis

Malignancy Segmental colectomy

0.78

1.4

0.20

Total colectomy

3.3

6.1

0.88

Proctectomy

2.0

3.6

0.53

J pouch

3.5

6.5

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J Am Coll Surg

CONCLUSIONS: Although VTE prevention guidelines focus primarily on malignancy, this study demonstrates that IBD patients may be at highest risk. Furthermore, rate of PVT, especially in those with IBD, is significant and may lead to substantial morbidity. These factors should be weighed in decisions about postoperative and post-discharge VTE prophylaxis in the CRS population.

Robot-Assisted vs Laparoscopic vs Open Abdominoperineal Resections for Low Rectal Cancer: Short-Term Outcomes of a Single-Center Randomized Controlled Trial Jianmin Xu, MD, PhD, Ye Wei, Qingyang Feng, MD, Jingwen Chen, MD, Dexiang Zhu, MD, PhD, Wenju Chang, MD, PhD, Tuo Yi, MD, Qi Lin, MD, PhD, Li Ren, Xinyu Qin, MD, FACS Zhongshan Hospital, Fudan University, Shanghai, China INTRODUCTION: Currently, robot-assisted surgery for rectal cancer using da Vinci System is common. However, few studies report abdominoperineal resections (APRs) for low rectal cancer using robotic approaches. This study aims to compare the safety and efficacy of robot-assisted, laparoscopic and open APRs for low rectal cancer. METHODS: This study is a single-center prospective randomized controlled trial. Since September 2013 patients aged from 18 to 75 years, with low rectal cancer (within 5 cm from the anal verge), with clinical T1 to T3 primary tumor, without any evidence of distant metastases or preoperative chemotherapy or radiotherapy were randomly assigned to either robot-assisted, laparoscopic, or open surgery in a 1:1:1 ratio. The study was not masked. The primary endpoint was perioperative complication rate. The secondary endpoints included operative findings, results at pathological examination, 3-year local recurrence rate, disease-free survival time and quality of life. This study is registered with ClinicalTrials.gov, number NCT01985698. RESULTS: Until December 2015, 344 patients were randomly assigned to receive robot-assisted procedures (RAP, n¼115), laparoscopic procedures (LAP, n¼115) and open surgery (OS, n¼114), and 314 were eligible for analyses (105 in RAP, 104 in LAP, 105 in OS). During the surgery, patients in RAP lost less blood (10219 mL) than both LAP (12635 mL, p<0.001) and OS (14155 mL, p<0.001). In terms of operating time, RAP (21017 min) was similar as LAP (20754 min, p¼0.927), but longer than OS (16648 min, p<0.001). No open conversion occurred in RAP, but 3 (2.9%) in LAP, with no significant difference (p¼ 0.121). After surgery, RAP had faster recovery, with significantly shorter days to first flatus (RAP 1.50.7 d, LAP 2.40.9 d, OS 2.41.0 d; RAP vs LAP, p<0.001; RAP vs OS, p<0.001) and significantly shorter days of retention catheterization (RAP 2.31.0 d, LAP 3.41.4 d, OS 3.01.2 d; RAP vs LAP, p<0.001; RAP vs OS, p<0.001). The hospital stay after surgery was also shorter in RAP (5.51.5 d) than in OS (6.32.2 d, p¼0.002), but not significantly shorter