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World Journal of Surgery

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01-12-2017 | Original Scientific Report

Retrosternal Reconstruction Can be a Risk Factor for Upper Extremity Deep Vein Thrombosis After Esophagectomy

Authors: Takamasa Takahashi, Masahide Fukaya, Kazushi Miyata, Yayoi Sakatoku, Masato Nagino

Published in: World Journal of Surgery | Issue 12/2017

Abstract

Background

Upper extremity deep vein thrombosis (UEDVT) is a rare but important complication because it can cause pulmonary embolism. The aim of this study was to investigate the incidence of UEDVT after esophagectomy and the risk factors related to UEDVT.

Methods

This study included 88 patients who underwent esophagectomy with retrosternal or posterior mediastinal reconstruction using gastric tube. The incidence of UEDVT and the diameter of left brachiocephalic vein were measured using postoperative contrast-enhanced computed tomography (CT). (a) The distance from sternum to brachiocephalic artery and (b) the distance from sternum to vertebra were measured by preoperative CT, and the ratio of (a) to (b) was defined as the width of the retrosternal space.

Results

Among the patients, 14 (15.9%) suffered from UEDVT. All UEDVTs were found in left-side upper extremity deep veins. Twelve of the 14 patients (85.7%) underwent retrosternal reconstruction. In a multivariate analysis, retrosternal reconstruction was an independent risk factor for UEDVT (odds ratio 5.48). The diameter of the left brachiocephalic vein in patients with retrosternal reconstruction was significantly smaller than that in patients with posterior mediastinal reconstruction (4.3 vs 6.9 mm; P < 0.001) due to compression of left brachiocephalic vein by the gastric tube. Among patients with retrosternal reconstruction, the width of the retrosternal space in patients with UEDVT was significantly smaller than that in patients without UEDVT (0.21 vs 0.27; P = 0.001).

Conclusion

Retrosternal reconstruction can be a risk factor for UEDVT. In patients with small width of the retrosternal space, retrosternal reconstruction might be inappropriate.

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Blom JW, Vanderschoot JP, Oostindier MJ et al (2006) Incidence of venous thrombosis in a large cohort of 66,329 cancer patients: results of a record linkage study. J Thromb Haemost JTH 4:529–535CrossRefPubMed

Heit JA, Silverstein MD, Mohr DN et al (2000) Risk factors for deep vein thrombosis and pulmonary embolism: a population-based case-control study. Arch Intern Med 160:809–815CrossRefPubMed

Blom JW, Doggen CJ, Osanto S et al (2005) Malignancies, prothrombotic mutations, and the risk of venous thrombosis. JAMA 293:715–722CrossRefPubMed

Martin JT, Mahan AL, Ferraris VA, et al (2015) Identifying esophagectomy patients at risk for predischarge versus postdischarge venous thromboembolism. Ann Thorac Surg 100: 932-938; discussion 938

De Martino RR, Goodney PP, Spangler EL et al (2012) Variation in thromboembolic complications among patients undergoing commonly performed cancer operations. J Vasc Surg 55:1035–1040.e1034CrossRefPubMedPubMedCentral

Mukherjee D, Lidor AO, Chu KM et al (2008) Postoperative venous thromboembolism rates vary significantly after different types of major abdominal operations. J Gastrointest Surg 12:2015–2022CrossRefPubMed

Mantziari S, Gronnier C, Pasquer A et al (2016) Incidence and risk factors related to symptomatic venous thromboembolic events after esophagectomy for cancer. Ann Thorac Surg 102:979–984CrossRefPubMed

Munoz FJ, Mismetti P, Poggio R et al (2008) Clinical outcome of patients with upper-extremity deep vein thrombosis: results from the RIETE Registry. Chest 133:143–148CrossRefPubMed

Levy MM, Albuquerque F, Pfeifer JD (2012) Low incidence of pulmonary embolism associated with upper-extremity deep venous thrombosis. Ann Vasc Surg 26:964–972CrossRefPubMed

10.

Mustafa S, Stein PD, Patel KC et al (2003) Upper extremity deep venous thrombosis. Chest 123:1953–1956CrossRefPubMed

11.

Becker DM, Philbrick JT, Walker FB (1991) Axillary and subclavian venous thrombosis. Prognosis and treatment. Archi Intern Med 151:1934–1943CrossRef

12.

Monreal M, Lafoz E, Ruiz J et al (1991) Upper-extremity deep venous thrombosis and pulmonary embolism. A prospective study. Chest 99:280–283CrossRefPubMed

13.

Grant JD, Stevens SM, Woller SC et al (2012) Diagnosis and management of upper extremity deep-vein thrombosis in adults. Thromb Haemost 108:1097–1108CrossRefPubMed

14.

Czihal M, Hoffmann U (2011) Upper extremity deep venous thrombosis. Vasc Med (London, England) 16:191–202CrossRef

15.

Maeda M, Goto T, Yamamura E et al (2007) Thrombosis of the left brachiocephalic vein after subtotal esophagectomy with reconstruction using a retrosternally shifted gastric tube: report of a case. Surg Today 37:145–149CrossRefPubMed

16.

Gawad KA, Hosch SB, Bumann D et al (1999) How important is the route of reconstruction after esophagectomy: a prospective randomized study. Am J Gastroenterol 94(1490–149):6

17.

Tachimori Y, Ozawa S, Numasaki H et al (2016) Comprehensive registry of esophageal cancer in Japan, 2009. Esophagus 13:110–137CrossRefPubMedPubMedCentral

18.

Miyata K, Fukaya M, Itatsu K, et al. Muscle sparing thoracotomy for esophageal cancer: a comparison with posterolateral thoracotomy Surg Today 2015

19.

Sobin LH, Gospodarowicz MK, Wittekind C (2009) TNM classification of malignant tumours, 7th edn. Wiley, New York

20.

Clavien PA, Barkun J, de Oliveira ML et al (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250(187–19):6

21.

Urschel JD, Urschel DM, Miller JD et al (2001) A meta-analysis of randomized controlled trials of route of reconstruction after esophagectomy for cancer. Am J Surg 182(470–47):5

22.

Takato T, Ashida T, Sugiyama T et al (2006) Marked reversible ST-T abnormalities induced by cardiac compression from a retrosternal gastric tube used to reconstruct the esophagus after tumor resection. A case of a diabetic patient and mini-review of 7 reported patients. Int Heart J 47:475–482CrossRefPubMed

23.

Santos GH, Ghalili K (1990) Axillosubclavian vein thrombosis produced by retrosternal thyroid. Chest 98:1281–1283CrossRefPubMed

24.

Joffe HV, Kucher N, Tapson VF et al (2004) Upper-extremity deep vein thrombosis: a prospective registry of 592 patients. Circulation 110:1605–1611CrossRefPubMed

25.

Tanizawa Y, Bando E, Kawamura T et al (2016) Prevalence of deep venous thrombosis detected by ultrasonography before surgery in patients with gastric cancer: a retrospective study of 1140 consecutive patients. Gastric Cancer. doi:10.1007/s10120-016-0677-2

26.

Bertoglio S, Faccini B, Lalli L et al (2016) Peripherally inserted central catheters (PICCs) in cancer patients under chemotherapy: a prospective study on the incidence of complications and overall failures. J Surg Oncol 113:708–714CrossRefPubMed

27.

Yukisawa S, Fujiwara Y, Yamamoto Y et al (2010) Upper-extremity deep vein thrombosis related to central venous port systems implanted in cancer patients. Br J Radiol 83:850–853CrossRefPubMedPubMedCentral

28.

Blom JW, Doggen CJ, Osanto S et al (2005) Old and new risk factors for upper extremity deep venous thrombosis. J Thromb Haemost JTH 3:2471–2478CrossRefPubMed

29.

Marshall-Webb M, Bright T, Price T et al (2017) Venous thromboembolism in patients with esophageal or gastric cancer undergoing neoadjuvant chemotherapy. Dis Esophagus 30:1–7PubMed

30.

Guy JB, Bertoletti L, Magne N et al (2017) Venous thromboembolism in radiation therapy cancer patients: findings from the RIETE registry. Crit Rev Oncol/Hematol 113(83–8):9

31.

Larsen AC, Frokjaer JB, Fisker RV et al (2015) Treatment-related frequency of venous thrombosis in lower esophageal, gastro-esophageal and gastric cancer—a clinical prospective study of outcome and prognostic factors. Thromb Res 135:802–808CrossRefPubMed

32.

Zhou W, Bush RL, Lin PH et al (2004) Radiation-associated venous stenosis: endovascular treatment options. J Vasc Surg 40:179–182CrossRefPubMed

33.

Bernardi E, Piccioli A, Marchiori A et al (2001) Upper extremity deep vein thrombosis: risk factors, diagnosis, and management. Semin Vasc Med 1:105–110CrossRefPubMed

34.

Dai JG, Zhang ZY, Min JX et al (2011) Wrapping of the omental pedicle flap around esophagogastric anastomosis after esophagectomy for esophageal cancer. Surgery 149:404–441CrossRefPubMed

35.

Zwischenberger BA, Tzeng CW, Ward ND et al (2016) Venous Thromboembolism prophylaxis for esophagectomy: a survey of practice patterns among thoracic surgeons. Ann Thorac Surg 101:489–494CrossRefPubMed

Title: Retrosternal Reconstruction Can be a Risk Factor for Upper Extremity Deep Vein Thrombosis After Esophagectomy
Authors: Takamasa Takahashi
Masahide Fukaya
Kazushi Miyata
Yayoi Sakatoku
Masato Nagino
Publication date: 01-12-2017
Publisher: Springer International Publishing
Published in: World Journal of Surgery / Issue 12/2017
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-017-4120-6

2024 ASCO Annual Meeting

Springer Medicine

Retrosternal Reconstruction Can be a Risk Factor for Upper Extremity Deep Vein Thrombosis After Esophagectomy

Abstract

Background

Methods

Results

Conclusion

2024 ASCO Annual Meeting

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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