ASO Author Reflections: Venous Thromboembolism After Esophagectomy—The Importance of an Optimal Strategy for Thromboprophylaxis

Excerpt

Esophagectomies are associated with more frequent postoperative venous thromboembolism (VTE) than other gastroenterological surgeries.1 This may be due to frequent smoking and alcohol consumption, which are risk factors for VTE and esophageal cancer. Moreover, the increased use of neoadjuvant therapy for locally advanced esophageal cancer can also affect frequent VTEs.2 Most previously reported incidences included only symptomatic VTE, therefore the true incidence rate while taking asymptomatic VTE into account was not known because of the lack of prospective observational studies. An optimal strategy for thromboprophylaxis after esophagectomy has not been well established. Several general guidelines for thromboprophylaxis in patients with cancer are commonly used; however, the incidence of postoperative VTE remains high. Moreover, previous studies suggested that 11% of patients who underwent esophagectomy experienced VTE after hospital discharge,3 and 14% of readmissions after esophagectomy were due to VTE.4 These results imply that the previous strategy is inadequate, and there is a population of patients requiring further thromboprophylaxis after esophagectomy. …