OGC P62 Preoperative IVC filter insertion for oesophagogastric cancer surgery patients

Abstract Background Venous thromboembolism (VTE) is a life-threatening complication in cancer patients undergoing oesophagogastric surgery. Oesophagogastric cancer patients are at high risk of developing perioperative VTE due to neoadjuvant chemotherapy, prolonged immobilisation, reduced oral intake, and increased risk of dehydration. NICE guideline [NG158] recommends considering an inferior vena cava (IVC) filter for patients with proximal deep vein thrombosis (DVT) or pulmonary embolism (PE) when anticoagulation treatment is contraindicated. This study evaluates the effectiveness and safety of preventing perioperative VTE recurrence via the preoperative insertion of the IVC filter after adopting this as a trust-wide policy in 2012. Methods This is a 10-year retrospective study from July 2012-2022. All patients who underwent cardio-oesophagectomy or gastrectomy for oesophagogastric cancers were included. All patients who underwent benign oesophagogastric surgery or local excision of GIST were excluded. The primary outcome includes the incidence of perioperative VTE recurrence following preoperative insertion of an IVC filter. The secondary outcome includes the inpatient and 30-day complications and mortality following the insertion of the IVC filter. Results 582 patients were included in our study. 37/582 (6.4%) patients developed preoperative VTE, in which 25/37 (67.6%) patients were diagnosed with PE, whereas 12/37 (32.4%) patients had proximal DVT. 30/37 (81.1%) patients underwent preoperative IVC filter insertion, while 7/37 (18.9%) did not. Of these 7 patients, 1 patient developed popliteal DVT 9 months after surgery. There was a statistically significant difference in preventing perioperative VTE recurrence through IVC filter insertion before surgery (p<0.05). IVC filters were safely removed in all patients postoperatively. No inpatient or postprocedural 30-day complications or mortality was identified. Conclusions This study has demonstrated that preoperative IVC filter insertion could prevent perioperative VTE recurrence in cancer patients who underwent oesophagogastric surgery. However, the retrospective nature of this study and the relatively small sample size are the main limitations. Preoperative IVC filter insertion is deemed safe, given no postprocedural morbidity or complications were identified.