Venous Thromboembolic Incidence With Neo-adjuvant Chemotherapy: Post Operative Prophylaxis Is Too Little, Too Late!

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Introduction

Patients with locally advanced oesophageal/gastric (OG) cancer routinely receive neo-adjuvant chemotherapy. Post operatively, in line with established guidelines, patients all receive 28 days of VTE prophylaxis. However, no guidelines exist for VTE prophylaxis in neo-adjuvant period, despite studies in OG cancer suggesting a higher incidence in the neo-adjuvant group versus surgery only group.

Aims

To establish the incidence of VTE during neo-adjuvant therapy in our patient group with a view to guiding future practice.

Methods

A review of the clinical records of those who received neo-adjuvant chemotherapy between 2013 and 2016 was performed. Data regarding the incidence, date and site of any VTE was recorded

Results

196 patients were identified (134 oesophagectomy, 62 gastrectomy). Within oesophagectomy group, incidence of pre-op VTE was 6.0% (8/134) and post-op incidence was 3.7% (5/134) Within gastrectomy group, incidence of pre-op VTE was 6.5 %( 4/62) (3 PE and 1 upper limb DVT) and postop incidence was 1.6%. Overall VTE rate in patients undergoing neo-adjuvant chemotherapy in the pre-op period was 5.6% (11/196) and postop period was 3.1% (6/196) with combined incidence of 8.7%(17/196).

Conclusion

Those receiving neo-adjuvant chemotherapy prior to resection are at significant risk of VTE. A recent literature review advises considering prophylaxis during neo-adjuvant treatment. Our experience would support this, but on an individual case by case basis. As cancer patient survival is known to be significantly lower in those who have a VTE, it may be possible to improve patient survival also. Our current regimen of only using VTE prophylaxis postoperatively may unfortunately be too late for some patients.