Factors affecting the development of venous thromboembolism in patients with lung cancer resection

OBJECTİVE: One of the most important causes of cancer-related deaths in the world is lung cancer. Surgical treatment is the most effective treatment method and is preferred in stage 1, 2 and selected stage 3 patients. One of the most important problems after lung cancer resection is venous thromboembolism (VTE). Both cancer and major surgery pose separate risks for VTE. VTE was detected at a rate of 2.3% in the period after lung resection. VTE is a significant cause of morbidity and mortality in thoracic surgery patients due to technical and disease-specific reasons. VTE is a preventable disease and attention should be paid to prophylaxis by being aware of risk factors. Our aim in this prospective cohort study is to determine the rate of VTE development and risk factors in lung cancer patients who underwent lung resection. MATERİALS AND METHODS: Our study included 45 patients who underwent surgery for lung cancer at the Bolu Abant İzzet Baysal University İzzet Baysal Training and Research Hospital, Department of Chest Surgery between September 2023 and December 2024. The dependent variable of the study was the presence of pulmonary embolism (PE) or deep vein thrombosis (DVT). The independent variables were the Caprini risk assessment model (Caprini RAM) score, descriptive characteristics of the study group, characteristics related to PE or DVT, risk factors of the study group, and characteristics related to additional diseases of the study group. FİNDİNGS: The median age of patients included in the study was 65 (31-79). There was a male predominance in the patients, with a female/male ratio of 8 (17.8%) to 37 (82.2%). The most common cancer type was adenocarcinoma. Patient staging was as follows; 26 (57.8%) were stage 1A, 6 (13.3%) were stage 1B, 5 (11.1%) were stage 2B, 5 (11.1%) were stage 4A, 2 (4.4%) were stage 2A, and 1 (2.2%) was stage 3A. 93.3% of patients had at least one comorbidity. The most common comorbidities were chronic obstructive pulmonary disease (COPD) (24.4%), coronary artery disease (CAD) (24.4%), and obesity (24.4%). Among comorbidities, only the presence of COPD was found to be associated with the development of PE/DVT (75% in group 1, 19.5% in group 2, p=0.04). 6 patients (13.3%) received neoadjuvant chemotherapy. 34 patients (75.6%) were operated on using video-assisted thoracic surgery (VATS), the most common procedure was lobectomy (57.8%, n=26). The mean surgery duration was 221.1±65.1 min. The median Caprini RAM value of the patients was 9 (6-14). 11 (24.4%) of the patients were in the high-risk Caprini RAM group, 34 (75.6%) were in the intermediate-risk group and we had no patients with low-risk Caprini RAM. 50% of those who developed PE/DVT had a high-risk Caprini RAM score, and when we grouped the patients according to the Caprini RAM score; Although PE/DVT developed in 18.2% of the high-risk group and 5.9% of the moderate-risk group, this result was not found to be statistically significant (p=0.247). PE/DVT developed in 4 of the patients (8.9%). The mean time for PE/DVT development was 94.2±34.8 days. DVT developed in 2 of these 4 patients (50%), and PE developed in the other 2 (50%). Thrombus localization was observed in a segmental branch in one of the patients who developed PE, and in the main pulmonary artery in the other. All patients who developed DVT were unilateral. 50% of the PE/DVT group died. RESULTS: In our study, it was determined that PE/DVT developed at a rate of 8.9% in patients with lung cancer resection, regardless of the type, extent and duration of surgery, type and stage of cancer, duration of hospitalization, timing of mobilization, development of postoperative complications, application of embolism prophylaxis and Caprini RAM score. The postoperative 4-month period is important in terms of development of PE/DVT and patients with high Caprini RAM scores in particular should be closely monitored. It is thought that the predicted score of COPD, one of the comorbidities included in Caprini RAM, which guides the duration of anticoagulant chemoprophylaxis, should be higher. KEYWORDS: Venous thromboembolism, pulmonary embolism, deep venous thrombosis, lung cancer, postoperative, Caprini RAM score, risk factors