Key result
Malignant gynecological disease shows similar 28-day mortality to benign disease in patients with preoperative VTE.
Why the study?
Optimal perioperative management strategies for patients with preoperatively diagnosed VTE undergoing gynecological surgery remain unclear, and management and outcomes may differ between malignant and benign diseases.
Do perioperative management and short-term outcomes differ between malignant and benign gynecological diseases in patients with preoperatively diagnosed VTE undergoing gynecological surgery?
Observational (n=1,406)
Yes
Do perioperative management and short-term outcomes differ between malignant and benign gynecological diseases in patients with preoperatively diagnosed VTE undergoing gynecological surgery?
In patients with preoperatively diagnosed VTE undergoing gynecological surgery, short-term outcomes including mortality and VTE recurrence are comparable between malignant and benign diseases despite more frequent postoperative anticoagulation in the malignant group.
Comparable short-term outcomes support similar perioperative strategies regardless of malignancy; leaves open optimal anticoagulation protocols.
AIM: Patients with preoperatively diagnosed venous thromboembolism (VTE) present complex management challenges, and optimal strategies for gynecological surgery remain unclear. Because malignancy is a major risk factor for VTE, perioperative management and outcomes may differ between malignant and benign gynecological diseases. This study aimed to compare perioperative management and short-term outcomes between these groups. METHODS: This retrospective observational study included 1406 patients with preoperatively diagnosed VTE undergoing gynecological surgery between 2020 and 2022 using the Japanese Society of Anesthesiologists database. Patients were divided into malignant (M-group, n = 1126) and benign (B-group, n = 280) groups. Clinical characteristics, treatment strategies, and postoperative outcomes within 28 days after surgery were compared. RESULTS: Of 1406 patients, 421 (29.9%) had pulmonary embolism, 161 (11.5%) had proximal deep vein thrombosis (DVT), and 824 (58.6%) had distal DVT. Direct oral anticoagulants were the most commonly used preoperative anticoagulants (61.3%), followed by unfractionated heparin (24.8%). Postoperative anticoagulation was more frequent in the M-group than in the B-group (57.5% vs. 44.6%; p < 0.001). The 28-day all-cause mortality (1.2% vs. 0.7%; p = 0.752), VTE recurrence (2.0% vs. 2.9%; p = 0.406), and major bleeding (1.1%; p = 0.220) were comparable between groups. CONCLUSIONS: This study provides real-world data on perioperative management and short-term outcomes in gynecological surgical patients with preoperatively diagnosed VTE in Japan. Prospective studies are required to establish optimal, risk-stratified perioperative management strategies.
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Kawaguchi et al. (2026) conducted an observational in Preoperatively diagnosed venous thromboembolism in gynecological surgery (n=1,406). Malignant gynecological disease vs. Benign gynecological disease was evaluated on 28-day all-cause mortality (p=0.752). Among gynecological surgery patients with preoperative VTE, malignant disease had similar 28-day all-cause mortality compared to benign disease (1.2% vs. 0.7%; p=0.752).
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