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Abstract
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Introduction:
The objective of this study to examine whether lymphadenectomy was associated with development of postoperative venous thromboembolic events, ultimately to identify an area for primary prevention of VTE in patients with endometrial cancer undergoing surgical management.
Methods:
Patients with endometrial cancer who underwent minimally invasive hysterectomy recorded in the American College of Surgeons National Surgical Quality Improvement (NSQIP) database between 2014 and 2017 were identified. Primary exposure was performance of lymphadenectomy. The primary outcome was VTE, including both DVT and PE. Associations were examined with bivariable tests and multivariable regression. Effect modification was performed using logistic regression.
Results:
A total of 19,162 women with endometrial cancer who underwent minimally invasive hysterectomy between 2014 and 2017 were identified. Of these, 10,523 underwent lymphadenectomy and 8,639 did not. The odds of DVT with lymphadenectomy versus without lymphadenectomy was 2.59 (1.329-5.046). When adjusted for BMI, cancer stage, operative time, and smoking status this remained significant at 2.473 (1.265-4.835). The odds of PE after minimally invasive surgery including lymphadenectomy versus without lymphadenectomy was 2.054 (1.281-3.464). When adjusted for BMI, cancer stage, operative time, and smoking status this remained significant at 1.928 (1.140-3.263).
Conclusion/Implications:
Lymphadenectomy is associated with increased risk of VTE in patients undergoing minimally invasive surgery for endometrial cancer. Based on this study, the number needed to treat to prevent PE is 333, and the number needed to treat for DVT is 200. The morbidity associated with VTE in patients undergoing minimally invasive surgery for endometrial cancer might be mitigated by prophylactic anticoagulation.
The objective of this study to examine whether lymphadenectomy was associated with development of postoperative venous thromboembolic events, ultimately to identify an area for primary prevention of VTE in patients with endometrial cancer undergoing surgical management.
Methods:
Patients with endometrial cancer who underwent minimally invasive hysterectomy recorded in the American College of Surgeons National Surgical Quality Improvement (NSQIP) database between 2014 and 2017 were identified. Primary exposure was performance of lymphadenectomy. The primary outcome was VTE, including both DVT and PE. Associations were examined with bivariable tests and multivariable regression. Effect modification was performed using logistic regression.
Results:
A total of 19,162 women with endometrial cancer who underwent minimally invasive hysterectomy between 2014 and 2017 were identified. Of these, 10,523 underwent lymphadenectomy and 8,639 did not. The odds of DVT with lymphadenectomy versus without lymphadenectomy was 2.59 (1.329-5.046). When adjusted for BMI, cancer stage, operative time, and smoking status this remained significant at 2.473 (1.265-4.835). The odds of PE after minimally invasive surgery including lymphadenectomy versus without lymphadenectomy was 2.054 (1.281-3.464). When adjusted for BMI, cancer stage, operative time, and smoking status this remained significant at 1.928 (1.140-3.263).
Conclusion/Implications:
Lymphadenectomy is associated with increased risk of VTE in patients undergoing minimally invasive surgery for endometrial cancer. Based on this study, the number needed to treat to prevent PE is 333, and the number needed to treat for DVT is 200. The morbidity associated with VTE in patients undergoing minimally invasive surgery for endometrial cancer might be mitigated by prophylactic anticoagulation.
Introduction:
The objective of this study to examine whether lymphadenectomy was associated with development of postoperative venous thromboembolic events, ultimately to identify an area for primary prevention of VTE in patients with endometrial cancer undergoing surgical management.
Methods:
Patients with endometrial cancer who underwent minimally invasive hysterectomy recorded in the American College of Surgeons National Surgical Quality Improvement (NSQIP) database between 2014 and 2017 were identified. Primary exposure was performance of lymphadenectomy. The primary outcome was VTE, including both DVT and PE. Associations were examined with bivariable tests and multivariable regression. Effect modification was performed using logistic regression.
Results:
A total of 19,162 women with endometrial cancer who underwent minimally invasive hysterectomy between 2014 and 2017 were identified. Of these, 10,523 underwent lymphadenectomy and 8,639 did not. The odds of DVT with lymphadenectomy versus without lymphadenectomy was 2.59 (1.329-5.046). When adjusted for BMI, cancer stage, operative time, and smoking status this remained significant at 2.473 (1.265-4.835). The odds of PE after minimally invasive surgery including lymphadenectomy versus without lymphadenectomy was 2.054 (1.281-3.464). When adjusted for BMI, cancer stage, operative time, and smoking status this remained significant at 1.928 (1.140-3.263).
Conclusion/Implications:
Lymphadenectomy is associated with increased risk of VTE in patients undergoing minimally invasive surgery for endometrial cancer. Based on this study, the number needed to treat to prevent PE is 333, and the number needed to treat for DVT is 200. The morbidity associated with VTE in patients undergoing minimally invasive surgery for endometrial cancer might be mitigated by prophylactic anticoagulation.
The objective of this study to examine whether lymphadenectomy was associated with development of postoperative venous thromboembolic events, ultimately to identify an area for primary prevention of VTE in patients with endometrial cancer undergoing surgical management.
Methods:
Patients with endometrial cancer who underwent minimally invasive hysterectomy recorded in the American College of Surgeons National Surgical Quality Improvement (NSQIP) database between 2014 and 2017 were identified. Primary exposure was performance of lymphadenectomy. The primary outcome was VTE, including both DVT and PE. Associations were examined with bivariable tests and multivariable regression. Effect modification was performed using logistic regression.
Results:
A total of 19,162 women with endometrial cancer who underwent minimally invasive hysterectomy between 2014 and 2017 were identified. Of these, 10,523 underwent lymphadenectomy and 8,639 did not. The odds of DVT with lymphadenectomy versus without lymphadenectomy was 2.59 (1.329-5.046). When adjusted for BMI, cancer stage, operative time, and smoking status this remained significant at 2.473 (1.265-4.835). The odds of PE after minimally invasive surgery including lymphadenectomy versus without lymphadenectomy was 2.054 (1.281-3.464). When adjusted for BMI, cancer stage, operative time, and smoking status this remained significant at 1.928 (1.140-3.263).
Conclusion/Implications:
Lymphadenectomy is associated with increased risk of VTE in patients undergoing minimally invasive surgery for endometrial cancer. Based on this study, the number needed to treat to prevent PE is 333, and the number needed to treat for DVT is 200. The morbidity associated with VTE in patients undergoing minimally invasive surgery for endometrial cancer might be mitigated by prophylactic anticoagulation.
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