Procedure-specific Risks of Thrombosis and Bleeding in Urological Cancer Surgery: Systematic Review and Meta-analysis
Kari A O Tikkinen1, Samantha Craigie2, Arnav Agarwal3
1Departments of Urology and Public Health, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
European Urology
|March 27, 2017
Summary
This study quantifies baseline risks for venous thromboembolism (VTE) and bleeding after urological cancer surgery. Extended thromboprophylaxis is recommended for high-VTE risk procedures like cystectomy, but not for low-risk prostatectomies.
Area of Science:
- Urology
- Oncology
- Vascular Surgery
Background:
- Pharmacological thromboprophylaxis balances venous thromboembolism (VTE) risk against bleeding risk.
- This balance is determined by baseline risks of VTE and bleeding without prophylaxis.
- Estimating these baseline risks is crucial for informed clinical decisions in urological cancer surgery.
Purpose of the Study:
- To estimate the baseline risk of symptomatic VTE after urological cancer surgery.
- To estimate the baseline risk of bleeding requiring reoperation after urological cancer surgery.
- To inform the decision-making process regarding thromboprophylaxis in urological cancer patients.
Main Methods:
- Systematic review and meta-analysis of contemporary observational studies.
- Inclusion of studies with low risk of bias, accounting for thromboprophylaxis use and follow-up duration.
- GRADE approach used to assess the quality of evidence for derived baseline risk estimates.
Main Results:
- Included 71 studies across 14 urological cancer procedures; evidence quality was moderate to very low.
- High VTE risk (2.6-11.6%) and low bleeding risk (0.3%) observed in cystectomies.
- VTE risk in prostatectomies varied widely (0.2-15.7%), with bleeding risk (0.1-1.0%); renal procedures showed VTE risk of 0.7-11.6% and bleeding risk of 0.1-2.0%.
Conclusions:
- Extended thromboprophylaxis is indicated for high-VTE risk procedures like open and robotic cystectomy.
- Routine extended thromboprophylaxis is not recommended for low-risk robotic prostatectomy without pelvic lymph node dissection (PLND).
- For procedures with intermediate risks, clinical decisions on thromboprophylaxis should consider patient values and preferences regarding VTE and bleeding.
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