The impact of laparoscopic versus open surgeries on the incidence of postoperative deep vein thrombosis in patients with gastrointestinal malignancy-a cohort study

Objectives: This study aims to comparison the incidence of laparoscopic and open procedures on venous thromboembolism in patients receiving gastrointestinal malignancy surgery. Methods: In consecutive patients who underwent laparoscopic or open surgery between December 2014 and November 2015 with a new diagnosis of gastrointestinal malignancy were included in this observational study. Data on patient demographics, characteristics, and perioperative outcomes, with particular emphasis on thromboembolism and coagulation function, were evaluated comparing laparoscopic and open gastrointestinal malignancy surgery. Results: A total of 148 patients completed the protocol and were included into outcomes analysis, 75 (50.7%) cases in LS group and 73 (49.3%) cases in OS group. Patients’ clinical features were close between the two groups. The total DVT incidence was 26.4% (laparoscopic 32.0% vs open 20.6%, P=0.043), and the symptomatic DVT incidence was 4.7% (5.3% vs 4.1%, P=1.0). The intraoperative arterial blood gas analysis (PaCO2 and pH value) had significant statistical differences in two groups (P<0.001 and P<0.001, resp). Laparoscopic and open cases had comparable operating time and blood loss (P=0.012 and P=0.023, resp). The rates of postoperative complications were similar between the two groups. The prothrombin time (PT) and activated partial thromboplastin time (APTT) were only decreased in LS group at the early postoperative period. After the surgery, the D-dimer levels were increased in both groups with the changes were more pronounced in the LS group, and the similar trend was found in TEG parameters, including alpha angle and MA. Conclusions: The gastrointestinal malignancy patients who received laparoscopic surgery had higher incidence of DVT by vascular Doppler ultrasound. Therefore, more attention should be paid to these patients in order to prevent the occurrence of fatal thrombotic events.