Venous thromboembolism in surgically treated sarcoma a systematic review and meta-analysis of orthopaedic oncology literature

Abstract Venous thromboembolism (VTE) is an important complication in patients with sarcoma undergoing surgery. Recent studies and commentary have suggested that VTE risk may be higher in bone sarcoma than in soft tissue sarcoma, although the evidence supporting this assumption remains uncertain. This systematic review and meta-analysis summarized the reported prevalence of VTE in surgically treated sarcoma patients, compared VTE prevalence between bone and soft tissue sarcoma, and evaluated the available evidence on thromboprophylaxis strategies. A systematic review was performed according to PRISMA guidelines using PubMed and EMBASE. Studies reporting VTE incidence in sarcoma patients undergoing operative intervention were included. Pooled VTE proportions were estimated using a random-effects model. Bone and soft tissue sarcoma cohorts were compared using meta-analysis of effect sizes. A network meta-analysis was also performed to compare reported thromboprophylaxis strategies and their association with VTE. Thirty-four studies were included, comprising 85,425 patients and 2,283 VTE events. The pooled proportion of VTE among surgically treated sarcoma patients was 4.5% (95% CI 3.2% to 6.3%). The pooled VTE proportion was 4.3% (95% CI 2.9% to 6.4%) for bone sarcoma and 3.4% (95% CI 1.5% to 7.9%) for soft tissue sarcoma, with no statistically significant difference between groups (p = 0.57). Substantial heterogeneity was present across studies (τ 2 = 1.24; I 2 = 94.5%), although sensitivity analyses accounting for outliers did not materially change the results. The network meta-analysis included 2,556 observations across eight prophylaxis strategies and 45 treatment-arm comparisons. No prophylaxis strategy demonstrated a statistically significant reduction in VTE risk compared with no prophylaxis. Heterogeneity in the network meta-analysis was lower (I 2 = 34.5%), but the findings were limited by study design, treatment-selection bias, and relatively few direct comparisons. Available published data do not demonstrate a higher prevalence of VTE in surgically treated bone sarcoma compared with soft tissue sarcoma. The pooled VTE prevalence of 4.5% is lower than some previously cited estimates, although this finding should be interpreted in the context of substantial heterogeneity and variable study quality. Current comparative data do not establish the superiority of any specific thromboprophylaxis strategy in sarcoma surgery. Higher-quality studies with consistent reporting of patient, tumour, treatment, and prophylaxis variables are needed to guide VTE risk stratification and prophylaxis in this population.