Incidence of postoperative venous thromboembolism in patients with vulvar carcinoma undergoing vulvectomy with or without lymphadenectomy

• Published in: Gynecologic oncology 2024-08, Vol.187, p.192-197
• Main Authors: Wagar, Matthew K., Naik, Aaditi, Zhang, Ran Catherine, Godecker, Amy, Hartenbach, Ellen M., Sobecki, Janelle N., Wallace, Sumer K.
• Format: Article
• Language: English
• Subjects: Venous thromboembolism; Vulvar cancer; Vulvar surgery
• ISSN: 0090-8258; 1095-6859; 1095-6859
• DOI: 10.1016/j.ygyno.2024.05.023

The incidence of venous thromboembolism (VTE) following radical surgery for vulvar carcinoma remains poorly characterized, and recommendations for postoperative chemoprophylaxis are varied. Our objective was to assess the incidence of postoperative VTE in patients undergoing surgery for vulvar carcinoma and to determine if VTE incidence differs by radical vulvectomy with or without lymph node assessment. The American College of Surgeons National Surgical Quality Improvement Program database was queried for patients with a diagnosis of vulvar cancer undergoing radical vulvectomy with or without lymph node assessment from 2012 to 2020. Clinical characteristics and 30-day incidence of VTE as well as other postoperative outcomes were abstracted. Variables were compared using Chi-square test and Fischer's exact test, as well as Kruskal-Wallis and Wilcoxon rank sum tests where appropriate. A total of 1672 patients underwent radical vulvectomy for vulvar carcinoma. 11 patients (0.7%) experienced postoperative VTE within 30 days of surgery. The incidence of VTE was similar when radical vulvectomy was performed alone or with lymph node dissection by any method (p = 0.116). Longer operative times (p = 0.033) and greater postoperative length of stay (p = 0.001) were associated with increased risk of postoperative VTE. The incidence of postoperative VTE is low in patients undergoing radical vulvar surgery in this national cohort. Inguinofemoral lymph node dissection by any method does not appear to be a risk factor for VTE when compared to radical vulvectomy alone. Further research is needed to determine if extended VTE prophylaxis is beneficial in this population. •Incidence of 30-day postoperative venous thromboembolism is low in patients undergoing radical vulvar surgery.•No difference in rates of postoperative VTE by method of inguinofemoral lymph node dissection.•Increased OR time is associated with increased risk of 30-day postoperative VTE.•Extended chemoprophylaxis for VTE is unlikely to be beneficial in for vulvar cancer patients undergoing radical vulvectomy.