Top

Published in:

01-08-2018

Laparoscopic surgery in colon cancer patients treated with chronic anti-thrombotic therapy

Authors: Hiroaki Nozawa, Takahide Shinagawa, Kazushige Kawai, Keisuke Hata, Toshiaki Tanaka, Takeshi Nishikawa, Kensuke Otani, Kazuhito Sasaki, Manabu Kaneko, Shigenobu Emoto, Koji Murono

Published in: Surgical Endoscopy | Issue 8/2018

Abstract

Background

Anti-thrombotic medications are commonly used for the treatment and prevention of cardiovascular diseases. Laparoscopic resection of colon cancer has generally been accepted with favorable outcomes being reported in randomized control trials. However, the safety and efficacy of laparoscopic surgery for colon cancer patients receiving chronic anti-thrombotic therapy (AT) remain unclear.

Methods

We identified 951 patients who underwent elective resection for colon cancer between 2009 and 2016 from our database. Patients were classified according to the surgical approach and chronic AT. Clinicopathological factors and surgical outcomes were analyzed between patient groups. Patients’ backgrounds were matched using propensity scores in laparoscopic surgery.

Results

Anti-thrombotic drugs were chronically used in 135 patients. Among 714 patients who underwent laparoscopy-assisted surgery, 96 received AT. The laparoscopic approach was superior to open surgery in terms of bleeding, surgical site infections, and hospital stay in patients receiving AT. In laparoscopy-assisted surgery, the AT group patients were older and showed lower hemoglobin and albumin levels than those not receiving AT (non-AT group), and were predominantly male. After propensity score matching, estimated blood loss and operative times were similar between the two groups (93 matched patients). The frequencies of postoperative bleeding (2.2%) and thrombotic complications (0%) in the AT group did not significantly differ from those in the non-AT group (1.1 and 0%, respectively). Moreover, AT did not affect survivals.

Conclusion

Laparoscopic approach appears to be safer and beneficial for colonic cancer patients receiving long-term AT. Bleeding and thrombotic events associated with laparoscopic surgery were not significantly affected by AT.

Available only for authorised users

Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, Das SR, de Ferranti S, Després JP, Fullerton HJ, Howard VJ, Huffman MD, Isasi CR, Jiménez MC, Judd SE, Kissela BM, Lichtman JH, Lisabeth LD, Liu S, Mackey RH, Magid DJ, McGuire DK, Mohler ER 3rd, Moy CS, Muntner P, Mussolino ME, Nasir K, Neumar RW, Nichol G, Palaniappan L, Pandey DK, Reeves MJ, Rodriguez CJ, Rosamond W, Sorlie PD, Stein J, Towfighi A, Turan TN, Virani SS, Woo D, Yeh RW, Turner MB; American Heart Association Statistics Committee; Stroke Statistics Subcommittee (2016) Heart Disease and Stroke Statistics-2016 Update: A Report From the American Heart Association. Circulation 133:e38–e360

Toyoda K, Yasaka M, Iwade K, Nagata K, Koretsune Y, Sakamoto T, Uchiyama S, Gotoh J, Nagao T, Yamamoto M, Takahashi JC, Minematsu K; Bleeding with Antithrombotic Therapy (BAT) Study Group (2008) Dual antithrombotic therapy increases severe bleeding events in patients with stroke and cardiovascular disease: a prospective, multicenter, observational study. Stroke 39:1740–1745CrossRefPubMed

Ogawa S, Koretsune Y, Yasaka M, Aizawa Y, Atarashi H, Inoue H, Kamakura S, Kumagai K, Mitamura H, Okumura K, Sugi K, Yamashita T (2011) Antithrombotic therapy in atrial fibrillation. Circ J 75:1539–1547CrossRefPubMed

Katsuno G, Fukunaga M, Nagakari K, Yoshikawa S, Ouchi M, Hirasaki Y (2011) Single-incision laparoscopic colectomy for colon cancer: early experience with 31 cases. Dis Colon Rectum 54:705–710CrossRefPubMed

Ercan M, Bostanci EB, Ozer I, Ulas M, Ozogul YB, Teke Z, Akoglu M (2010) Postoperative hemorrhagic complications after elective laparoscopic cholecystectomy in patients receiving long-term anticoagulant therapy. Langenbecks Arch Surg 395:247–253CrossRefPubMed

Chechik O, Inbar R, Danino B, Lador R, Greenberg R, Avital S (2011) Anti-platelet therapy: no association with increased blood loss in patients undergoing open or laparoscopic appendectomy. Isr Med Assoc J 13:342–344PubMed

Kefer JC, Desai MM, Fergany A, Novick AC, Gill IS (2008) Outcomes of partial nephrectomy in patients on chronic oral anticoagulant therapy. J Urol 180:2370–2374CrossRefPubMed

Varkarakis IM, Rais-Bahrami S, Allaf ME, Lima GC, Permpongkosol S, Rao P, Jarrett TW, Kavoussi LR (2005) Laparoscopic renal-adrenal surgery in patients on oral anticoagulant therapy. J Urol 174:1020–1023CrossRefPubMed

Yoshida T, Kitano S, Matsumoto T, Bandoh T, Baatar D, Ninomiya K, Hadama T (1998) Laparoscopic cholecystectomy in patients undergoing anticoagulant therapy. Surg Today 28:308–312CrossRefPubMed

10.

Mourelo R, Kaidar-Person O, Fajnwaks P, Roa PE, Pinto D, Szomstein S, Rosenthal RJ (2008) Hemorrhagic and thromboembolic complications after bariatric surgery in patients receiving chronic anticoagulation therapy. Obes Surg 18:167–170CrossRefPubMed

11.

Watanabe T, Muro K, Ajioka Y, Hashiguchi Y, Ito Y, Saito Y, Hamaguchi T, Ishida H, Ishiguro M, Ishihara S, Kanemitsu Y, Kawano H, Kinugasa Y, Kokudo N, Murofushi K, Nakajima T, Oka S, Sakai Y, Tsuji A, Uehara K, Ueno H, Yamazaki K, Yoshida M, Yoshino T, Boku N, Fujimori T, Itabashi M, Koinuma N, Morita T, Nishimura G, Sakata Y, Shimada Y, Takahashi K, Tanaka S, Tsuruta O, Yamaguchi T, Yamaguchi N, Tanaka T, Kotake K, Sugihara K; Japanese Society for Cancer of the Colon and Rectum (2017) Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2016 for the treatment of colorectal cancer. Int J Clin Oncol. https://doi.org/10.1007/s10147-017-1101-6 PubMedCentralCrossRefPubMed

12.

Brierley JD, Gospodarowicz MK, Wittekind C (eds) (2016) TNM Classification of malignant tumors, 8th edn. Wiley, New Jersey

13.

Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications. A new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213CrossRefPubMedPubMedCentral

14.

Lacy AM, García-Valdecasas JC, Delgado S, Castells A, Taurá P, Piqué JM, Visa J (2002) Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet 359:2224–2229CrossRefPubMed

15.

The Clinical Outcomes of Surgical Therapy Study Group (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350:2050–2059CrossRef

16.

Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, Heath RM, Brown JM; MRC CLASICC trial group (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 365:1718–1726CrossRefPubMed

17.

Veldkamp R, Kuhry E, Hop WC, Jeekel J, Kazemier G, Bonjer HJ, Haglind E, Påhlman L, Cuesta MA, Msika S, Morino M, Lacy AM; COlon cancer Laparoscopic or Open Resection Study Group (COLOR) (2005) Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol 6:477–484CrossRefPubMed

18.

Sulu B, Aytac E, Stocchi L, Vogel JD, Kiran RP (2013) The minimally invasive approach is associated with reduced perioperative thromboembolic and bleeding complications for patients receiving preoperative chronic oral anticoagulant therapy who undergo colorectal surgery. Surg Endosc 27:1339–1345CrossRefPubMed

19.

Liu YY, Yeh CN, Lee HL, Chu PH, Jan YY, Chen MF (2009) Laparoscopic cholecystectomy for gallbladder disease in patients with severe cardiovascular disease. World J Surg 33:1720–1726CrossRefPubMed

20.

Kuderer NM, Khorana AA, Lyman GH, Francis CW (2007) A meta-analysis and systematic review of the efficacy and safety of anticoagulants as cancer treatment: impact on survival and bleeding complications. Cancer 110:1149–1161CrossRefPubMed

21.

Kakkar AK, Macbeth F (2010) Antithrombotic therapy and survival in patients with malignant disease. Br J Cancer 102:S24-S29PubMedCentral

22.

Lip GY, Durrani OM, Roldan V, Lip PL, Marin F, Reuser TQ (2011) Perioperative management of ophthalmic patients taking antithrombotic therapy. Int J Clin Pract 65:361–371CrossRefPubMed

23.

Wille-Jørgensen P, Rasmussen MS, Andersen BR, Borly L (2003) Heparins and mechanical methods for thromboprophylaxis in colorectal surgery. Cochrane Database Syst Rev 4:CD001217

24.

Deitelzweig SB, Lin J, Lin G (2011) Preventing venous thromboembolism following orthopedic surgery in the United States: impact of special populations on clinical outcomes. Clin Appl Thromb Hemost 17:640–650CrossRefPubMed

25.

Stone DH, Goodney PP, Schanzer A, Nolan BW, Adams JE, Powell RJ, Walsh DB, Cronenwett JL; Vascular Study Group of New England (2011) Clopidogrel is not associated with major bleeding complications during peripheral arterial surgery. J Vasc Surg 54:779–784CrossRefPubMedPubMedCentral

26.

Yu WS, Jung HS, Lee JG, Kim DJ, Chung KY, Lee CY (2015) Safety of thoracoscopic surgery for lung cancer without interruption of anti-platelet agents. J Thorac Dis 7:2024–2032PubMedPubMedCentral

27.

Mantz J, Samama CM, Tubach F, Devereaux PJ, Collet JP, Albaladejo P, Cholley B, Nizard R, Barré J, Piriou V, Poirier N, Mignon A, Schlumberger S, Longrois D, Aubrun F, Farèse ME, Ravaud P, Steg PG; Stratagem Study Group (2011) Impact of preoperative maintenance or interruption of aspirin on thrombotic and bleeding events after elective non-cardiac surgery: the multicentre, randomized, blinded, placebo-controlled, STRATAGEM trial. Br J Anaesth 107:899–910CrossRefPubMed

28.

Fujikawa T, Tanaka A, Abe T, Yoshimoto Y, Tada S, Maekawa H, Shimoike N (2013) Does antiplatelet therapy affect outcomes of patients receiving abdominal laparoscopic surgery? Lessons from more than 1,000 laparoscopic operations in a single tertiary referral hospital. J Am Coll Surg 217:1044–1053CrossRefPubMed

Title: Laparoscopic surgery in colon cancer patients treated with chronic anti-thrombotic therapy
Authors: Hiroaki Nozawa
Takahide Shinagawa
Kazushige Kawai
Keisuke Hata
Toshiaki Tanaka
Takeshi Nishikawa
Kensuke Otani
Kazuhito Sasaki
Manabu Kaneko
Shigenobu Emoto
Koji Murono
Publication date: 01-08-2018
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 8/2018
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-018-6071-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Laparoscopic surgery in colon cancer patients treated with chronic anti-thrombotic therapy

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 8/2018

Effect of the application of a bundle of three measures (intraperitoneal lavage with antibiotic solution, fascial closure with Triclosan-coated sutures and Mupirocin ointment application on the skin staples) on the surgical site infection after elective laparoscopic colorectal cancer surgery

Surgery for benign esophageal disorders in the US: risk factors for complications and trends of morbidity

Posterior retroperitoneoscopic thoracic duct ligation: a novel surgical approach

Minimally invasive colorectal surgery in the morbid obese: does size really matter?

A step towards stereotactic navigation during pelvic surgery: 3D nerve topography

Treatment of benign perforations and leaks of the esophagus: factors associated with success after stent placement