The Impact Of Laparoscopic Versus Open Surgeries On The Incidence Of Postoperative Deep Vein Thrombosis In Patients With Gastrointestinal Malignancy—A Cohort Study

PartⅠ Similar Postoperative Venous Thromboembolism Incidence between Laparoscopic and Open Surgery for Colorectal or Gastric Cancer---a meta-analysisObject The present meta-analysis was conducted to evaluate the incidence of venous thromboembolism(VTE), mainly include including deep venous thromboembolism(DVT) and pulmonary embolism(PE), after laparoscopic or open surgery for both colorectal and gastric cancer.Methods Literatures were systematically searched in the database of Medline, EMBASE, and the Cochrane Central Register of Controlled Trials(CENTRAL). 11 randomized controlled trials(RCTs) involving 3318 patients received surgery for colorectal cancer(1687 patients received laparoscopic surgery, 1631 received open surgery) and 6 non-RCTs involving 542 patients received surgery for gastric cancer( 265 patients received laparoscopic surgery, 277 received open surgery) was reviewed.Results The pooled analysis of individual trials revealed no statistically significant difference in the incidence of VTE among patents received laparoscopic surgery compared with open surgery neither for colorectal cancer( odd ratio, 0.85 [0.44, 1.62]) nor gastric cancer(0.35 [0.09, 1.32]).Conclusions There is similar venous thromboembolism incidence between laparoscopic and open surgery for colorectal or gastric Cancer. PartⅡ The Impact of Laparoscopic Versus Open Surgeries on the Incidence of Postoperative Deep Vein Thrombosis in Patients With Gastrointestinal Malignancy---A Cohort StudyObject This study aims to comparison the incidence of laparoscopic and open procedures on venous thromboembolism in patients receiving gastrointestinal malignancy surgery.Methods In consecutive patients who underwent laparoscopic or open surgery between Dec 1,2014 and Nov 30,2015 with a new diagnosis of gastrointestinal malignancy were included in this observational study. Data on patient demographics, characteristics, and perioperative outcomes, with particular emphasis on thromboembolism and coagulation function, were evaluated comparing laparoscopic and open gastrointestinal malignancy surgery.Results A total of 148 patients completed the protocol and were included into outcomes analysis, 75(50.7%) cases in LS group and 73(49.3%) cases in OS group. Patients’ clinical features were close between the two groups. The total DVT incidence was 27.0%(laparoscopic 34.6% vs open 19.2%, P=0.043), and the symptomatic DVT incidence was 4.7%(5.3% vs 4.1%, P=1.0). The intraoperative arterial blood gas analysis(Pa CO2 and p H value) had significant statistical differences in two groups(P<0.001 and P<0.001, resp.). Laparoscopic and open cases had comparable operating time and blood loss(P=0.012 and P=0.023, resp.). The rates of postoperative complications were similar between the two groups. The prothrombin time(PT) and activated partial thromboplastin time(APTT) were only decreased in LS group at the early postoperative period. After the surgery, the D-dimer levels were increased in both groups with the changes were more pronounced in the LS group, and the similar trend was found in TEG parameters, including alpha angle and MA. ROC analysis of TEG parameter at the end of surgery to predict DVT: alpha angle AUC 0.822(0.743-0.902), cut-off value of alpha angle: 66.05; MA AUC 0.846(0.773-0.918), cut-off value of MA: 63.85.Conclusions Incidence of symptomatic DVT is similar between laparoscopic surgery and open surgery for patients with gastrointestinal malignancy, but laparoscopic surgery has higher incidence of asymptomatic DVT. TEG test at the end of surgery has moderate predicted efficacy for DVT with 7 days postoperatively for patients with gastrointestinal malignancy.