Risk factors for bleeding in patients receiving fondaparinux after colorectal cancer surgery.

OBJECTIVE: The aim of this study was to identify risk factors for bleeding complications in patients who receive Venous thromboembolism (VTE) prophylaxis with fondaparinux (FPX) after colorectal cancer surgery. METHODS: Records of 546 patients who underwent VTE prophylaxis with intermittent pneumatic compression and FPX after colorectal cancer surgery between January 2009 and May 2014 were reviewed. Patient characteristics, surgical procedures, and patient laboratory data were examined to identify risk factors for bleeding complications using univariate and multivariate logistic regression. RESULTS: We reviewed the records of 324 males and 222 females. Median age and BMI were 68.5 years and 22.7 kg/m2, respectively. The number of laparoscopic surgeries was 366. Median operative time and blood loss were 188.5 min and 20 ml, respectively. The incidence (%) of bleeding events was 5.3%. In univariate analysis, age ≥80 years, BMI ≥25.0 kg/m2, hypertension, and antithrombotic therapy were associated with a significantly higher incidence of bleeding events. Multivariate analysis identified age ≥80 years (odds ratio 5.814; 95% confidence interval 2.502-13.278) as an independent risk factor. CONCLUSION: Age ≥80 is a risk factor for bleeding in patients who receive FPX for VTE prophylaxis after colorectal cancer surgery.

[A Case of Esophageal Cancer with Paraaortic Lymph Node Metastasis Treated with Lymphadenectomy after Esophagectomy].

A 70-year-old woman underwent subtotal esophagectomy with two-field lymph node dissection for squamous cell carcinoma of the middle thoracic esophagus (type 0- /Ⅱa+Ⅱc, pT1bN1 [2/25] M0, pStage Ⅱ). Approximately 1 year and 2 months after surgery, abdominal CT showed a swollen paraaorticlymph node. PET-CT also indicated lymph node metastasis. The lymph node was diagnosed to have metastasis from the esophageal cancer, and the patient began treatment with chemotherapy. However, the treatment plan was changed to lymphadenectomy because of neutropenia. She underwent paraaortic lymph node dissection and right partial adrenalectomy. The lymph node was confirmed to have metastasis from the esophageal cancer. The neutropenia persisted after surgery, so she did not receive adjuvant chemotherapy. The patient remained alive for more than 5 years after surgery without any evidence of recurrence. Isolated paraaortic lymph node metastasis after esophagectomy is rare, and there have been only 2 cases, including our own, of long-term survival after paraaortic lymph node dissection. Lymphadenectomy for isolated lymph node metastasis can improve long-term prognosis but it cannot sufficiently predicate it. Therefore, accumulation of more cases is required.