与高温热化疗联合治疗的结直肠癌患者中，血栓素生成升高及静脉血栓栓塞症发生率增加

Elevated Thrombin Generation and Venous Thromboembolism Incidence in Patients Undergoing Cytoreductive Surgery with Hyperthermic Intraperitoneal Chemotherapy Compared with Minimally Invasive Rectal Surgery

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THROMBOSIS AND HAEMOSTASIS

影响因子:4.3

分区:医学2区 Top / 血液学2区外周血管病2区

发表日期:2025 May

作者: Mikkel Lundbech, Andreas E Krag, Lene H Iversen, Birgitte Brandsborg, Nina Madsen, Anne-Mette Hvas

DOI: 10.1055/a-2413-4989

摘要

结直肠癌的手术治疗存在静脉血栓栓塞（VTE）的风险。我们研究了接受开腹结直肠癌细胞减灭术结合热灌注化疗（CRS+HIPEC）治疗腹膜转移的患者，以及接受微创手术（MIS）治疗局部直肠癌患者的凝血和纤溶变化，以及30天内的VTE发生率。本队列研究包括45例CRS+HIPEC和45例MIS患者。血样在手术前、手术结束时以及术后第1天、第3-4天和第5-7天采集。在第3至7天期间进行系统性超声筛查VTE，若怀疑并发症，则进行CT扫描。主要终点为从术前到手术结束时血浆凝血酶片段1+2（F1+2）水平变化的平均值差（Δ）及其95%置信区间（CI）。次要终点包括从术前到第5-7天血液生物标志物变化的平均值差和VTE发生率。结果显示，两组在手术结束时F1+2水平均升高，但在CRS+HIPEC组的升高幅度明显大于MIS组：Δ1,322 [1,040:1,604] pmol/L，p<0.01。CRS+HIPEC组的VTE发生率显著高于MIS组（24% vs. 5%，p=0.01）。F1+2水平在两种手术中均升高，但在CRS+HIPEC后升高更为显著，30天内VTE的发生率也明显更高。所有研究结果均由Thieme版权所有。

Abstract

Surgical treatment of colorectal cancer carries a risk for venous thromboembolism (VTE). We investigated changes in coagulation and fibrinolysis and the VTE incidence within 30 days in patients undergoing open cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS + HIPEC) for peritoneal metastases from colorectal cancer and minimally invasive surgery (MIS) for localized rectal cancer.This cohort study included 45 CRS + HIPEC and 45 MIS patients. Blood samples were obtained preoperatively, at the end of surgery, and postoperative day (POD) 1, 3 to 4, and 5 to 7. Systematic ultrasonographic screening for VTE was performed between POD 3 and 7. Computed tomography scan was performed if complications were suspected. The primary endpoint was the difference in mean change (Δ) with [95% confidence intervals] from preoperative to end of surgery in prothrombin fragment 1 + 2 (F1 + 2) levels. Secondary endpoints were the difference in mean change in biomarkers of coagulation and fibrinolysis from preoperative to POD 5 to 7 and the VTE incidence.F1 + 2 levels increased from preoperative to the end of surgery in both groups. The mean increase from preoperative to end of surgery in F1 + 2 levels was significantly greater in CRS + HIPEC patients than MIS patients: Δ1,322 [1,040:1,604] pmol/L, p < 0.01. The VTE incidence was significantly higher after CRS + HIPEC than MIS (24 vs. 5%, p = 0.01).F1 + 2 levels were increased after both procedures, but to a far greater extent following CRS + HIPEC. The VTE incidence within 30 days was significantly higher in patients treated with CRS + HIPEC than in MIS patients.Thieme. All rights reserved.