Perioperative Incidence of Venous Thromboembolism in Bladder Cancer Patients Treated by Open Radical Cystectomy

(Objective) Venous thromboembolism (VTE) is a significant complication during the perioperative period in urological cancer surgery. However, the study of perioperative VTE among Japanese patients remains insufficient. We conducted a retrospective investigation into the incidence of perioperative VTE in bladder cancer patients who underwent open radical cystectomy (ORC). (Materials and methods) From April 2020 to October 2023, 60 patients received ORC at our hospital. Of these, we included 57 patients in this retrospective study. Preoperatively, lower limb venous ultrasound was conducted to assess for deep vein thrombosis in patients with high D-dimer levels, and postoperatively, it was performed on all patients the day after surgery. We analyzed the incidence of perioperative VTE and the factors associated with it. (Results) Preoperatively, of 57 patients, 13 (22.8%) were diagnosed with VTE, and of these 13, 4 had pulmonary embolism (PE). Postoperatively, among the 44 patients without preoperative VTE, 7 (15.9%) developed new VTE immediately after surgery, and an additional 4 (9.1%) developed VTE during hospitalization. Of these 11 patients, 3 (6.8%) had concurrent PE. There were no fatal cases associated with VTE either before or after surgery. The patients with preoperative VTE had a significantly higher proportion of females who had undergone two or more courses of neoadjuvant chemotherapy (NAC) compared to the patients without preoperative VTE. Furthermore, both pre-and post-operatively, patients with VTE had significantly higher D-dimer levels. (Conclusion) In patients undergoing ORC, there was a connection between NAC and preoperative VTE. However, early intervention prevented fatal outcomes. As a result, we believe perioperative VTE screening is useful, particularly in patients treated with ORC.