Venous thromboembolism in patients receiving multimodality therapy for thoracic malignancies Academic Article uri icon

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  • OBJECTIVE: The rate of venous thromboembolism in patients undergoing multimodality therapy for lung malignancy and the impact of preoperative venous thromboembolism on postoperative outcome have not been analyzed systematically. METHODS: We performed a retrospective review of all patients undergoing induction therapy before lung resection for non-small cell lung cancer and malignant pleural mesothelioma at the University Health Network between January 1996 and December 2007. RESULTS: Venous thromboembolism developed in 23 (12.3%) of 186 patients undergoing induction therapy. The venous thromboembolism was diagnosed during induction therapy in 11 patients. The proportion of pulmonary embolism was higher during induction therapy (9/11 patients), whereas deep venous thromboses were observed predominantly postoperatively (7/12 patients) (P = .02). The risk of postoperative complications or death was not increased in patients undergoing surgery despite a preoperative diagnosis of venous thromboembolism. However, the risk of postoperative pulmonary embolism was higher in patients undergoing surgery without insertion of an inferior vena cava filter (1/2 patients vs 0/7 after insertion of an inferior vena cava filter, P = .047). The overall survival was similar between patients with or without venous thromboembolism complications. CONCLUSION: This study demonstrates that venous thromboembolism events in patients undergoing multimodality therapy for lung malignancies is high and deserves careful consideration. Patients with a venous thromboembolism diagnosis during induction therapy may potentially benefit from a temporary inferior vena cava filter before surgery to limit the risk of recurrent pulmonary embolism. A preoperative diagnosis of venous thromboembolism, however, does not affect early and late outcomes after surgery and should not be viewed as a negative prognostic marker.


  • Patel, Apurva
  • Anraku, Masaki
  • Darling, Gail E
  • Shepherd, Frances A
  • Pierre, Andrew F
  • Waddell, Thomas K
  • Keshavjee, Shafique
  • de Perrot, Marc

publication date

  • October 2009

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