Deep vein thrombosis (DVT) after laparoscopic hepatectomy may be high, and no effective risk assessment methods exist. The authors of a study published in the Journal of Hepatocellular Carcinoma estimated incidence of DVT after surgery and created a DVT risk nomogram.
The western hemisphere has well-established guidelines for thromboprophylaxis, but its application in Asia is generally more controversial.
The retrospective study included 355 patients at a single center in China with hepatocellular carcinoma (HCC) who underwent laparoscopic hepatectomy. Patients were split into a training set (n=243) and validation set (n=112). During the study period, 66 (18.6%) patients were diagnosed with DVT. All cases were asymptomatic and discovered with lower extremity color flow Doppler. No pulmonary embolisms occurred.
A total of 72.7% of patients had viral hepatitis, which is related to a high risk of VTE in patients with cancer. Age, sex, body mass index (BMI), comorbidities and operative position (OPP) were found to be independent risk factors of DVT in a multivariate analysis. These factors were used to develop a risk score algorithm.
The authors developed a DVT risk nomogram (TRN) for clinical application and compared the nomogram to the Caprini score, a measure widely used in surgical departments. All patients in the study scored 5 or greater on the Caprini scale, which means all were at high risk of DVT.
In the training set, the TRN had an area under the curve (AUC) of 0.861 and an AUC of 0.818 in the validation set. The Caprini score had an AUC of 0.610, significantly lower than the TRN (P <.001).
The TRN had a sensitivity of 44.4%, specificity of 96.5%, positive predictive value (PPV) of 74.1% and negative predictive value (NPV) of 88.4%, and accuracy of 86.8% in the training set with similar results in the validation set.
Further studies are needed to validate the TRN, but the nomogram may accurately predict the risk of DVT after liver surgery for patients with HCC.
Chen Y, Zhao J, Zhang Z, et al. Construction and validation of a nomogram for predicting the risk of deep vein thrombosis in hepatocellular carcinoma patients after laparoscopic hepatectomy: a retrospective study. J Hepatocell Carcinoma. 2021;8:783-794. doi:10.2147/JHC.S311970