Patients Undergoing Oesophageal Cancer Surgery Do Not Have Impaired Haemostasis

Tua Gyldenholm; Nina Madsen; Niels Katballe; Daniel Willy Kjær; Thomas Decker Christensen; Anne Mette Hvas

doi:10.1177/10760296251327587

Patients Undergoing Oesophageal Cancer Surgery Do Not Have Impaired Haemostasis

Tua Gyldenholm^*, Nina Madsen, Niels Katballe, Daniel Willy Kjær, Thomas Decker Christensen, Anne Mette Hvas

^*Corresponding author af dette arbejde

Publikation: Bidrag til tidsskrift/Konferencebidrag i tidsskrift /Bidrag til avis › Tidsskriftartikel › Forskning › peer review

Abstract

Background: Oesophagectomy is a major oncological surgical procedure. Previous studies have shown a wide range of bleeding during and after surgery, and it is unknown if perioperative bleeding associated with oesophagectomy is purely surgical in nature, or if it is exacerbated by impaired haemostasis. We aimed to perform a detailed investigation of the perioperative coagulation in patients undergoing oesophagectomy due to cancer. Methods: The study was a prospective study including adult patients with adeno- or squamous cell carcinoma referred for intended curative oesophagectomy. Operative bleeding volume and blood transfusions were recorded. Blood samples were collected at three timepoints: before, at the end of surgery, and on postoperative day one. Dynamic global haemostasis was investigated employing thromboelastometry (ROTEM^®). Platelet aggregation was analysed with a Multiplate Analyzer^®, and routine coagulation parameters were analysed. Results: We included 87 patients. Patients bled a median of 300 mL during surgery. One patient bled 1830 mL, while the remaining patients bled ≤1000 mL. Blood transfusions were administered to 14 (16%) patients. Median platelet aggregation was within the reference ranges at all time points. Platelet aggregation increased during surgery and normalised within 24 h. ROTEM^® analyses showed no perioperative significantly decrease of clot formation or clot strength. Routine coagulation parameters were overall normal. Conclusions: Severe perioperative bleeding was rare, and transfusions of blood products were used sparingly. Patients undergoing oesophagectomy due to cancer had an intact haemostasis with no sign of impaired haemostasis. Clinical trial registration: The trial was registered prior to initiation at www.clinicaltrials.gov (identification number NCT05067153).

Originalsprog	Engelsk
Tidsskrift	Clinical and Applied Thrombosis/Hemostasis
Vol/bind	31
Antal sider	9
ISSN	1076-0296
DOI	https://doi.org/10.1177/10760296251327587
Status	Udgivet - 17 mar. 2025

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10.1177/10760296251327587Licens: CC BY-NC

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title = "Patients Undergoing Oesophageal Cancer Surgery Do Not Have Impaired Haemostasis",

abstract = "Background: Oesophagectomy is a major oncological surgical procedure. Previous studies have shown a wide range of bleeding during and after surgery, and it is unknown if perioperative bleeding associated with oesophagectomy is purely surgical in nature, or if it is exacerbated by impaired haemostasis. We aimed to perform a detailed investigation of the perioperative coagulation in patients undergoing oesophagectomy due to cancer. Methods: The study was a prospective study including adult patients with adeno- or squamous cell carcinoma referred for intended curative oesophagectomy. Operative bleeding volume and blood transfusions were recorded. Blood samples were collected at three timepoints: before, at the end of surgery, and on postoperative day one. Dynamic global haemostasis was investigated employing thromboelastometry (ROTEM{\textregistered}). Platelet aggregation was analysed with a Multiplate Analyzer{\textregistered}, and routine coagulation parameters were analysed. Results: We included 87 patients. Patients bled a median of 300 mL during surgery. One patient bled 1830 mL, while the remaining patients bled ≤1000 mL. Blood transfusions were administered to 14 (16%) patients. Median platelet aggregation was within the reference ranges at all time points. Platelet aggregation increased during surgery and normalised within 24 h. ROTEM{\textregistered} analyses showed no perioperative significantly decrease of clot formation or clot strength. Routine coagulation parameters were overall normal. Conclusions: Severe perioperative bleeding was rare, and transfusions of blood products were used sparingly. Patients undergoing oesophagectomy due to cancer had an intact haemostasis with no sign of impaired haemostasis. Clinical trial registration: The trial was registered prior to initiation at www.clinicaltrials.gov (identification number NCT05067153).",

keywords = "haemostasis, oesophageal neoplasms, oesophagectomy, platelet aggregation, thromboelastography",

author = "Tua Gyldenholm and Nina Madsen and Niels Katballe and Kj{\ae}r, {Daniel Willy} and Christensen, {Thomas Decker} and Hvas, {Anne Mette}",

year = "2025",

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doi = "10.1177/10760296251327587",

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T1 - Patients Undergoing Oesophageal Cancer Surgery Do Not Have Impaired Haemostasis

AU - Gyldenholm, Tua

AU - Madsen, Nina

AU - Katballe, Niels

AU - Kjær, Daniel Willy

AU - Christensen, Thomas Decker

AU - Hvas, Anne Mette

PY - 2025/3/17

Y1 - 2025/3/17

N2 - Background: Oesophagectomy is a major oncological surgical procedure. Previous studies have shown a wide range of bleeding during and after surgery, and it is unknown if perioperative bleeding associated with oesophagectomy is purely surgical in nature, or if it is exacerbated by impaired haemostasis. We aimed to perform a detailed investigation of the perioperative coagulation in patients undergoing oesophagectomy due to cancer. Methods: The study was a prospective study including adult patients with adeno- or squamous cell carcinoma referred for intended curative oesophagectomy. Operative bleeding volume and blood transfusions were recorded. Blood samples were collected at three timepoints: before, at the end of surgery, and on postoperative day one. Dynamic global haemostasis was investigated employing thromboelastometry (ROTEM®). Platelet aggregation was analysed with a Multiplate Analyzer®, and routine coagulation parameters were analysed. Results: We included 87 patients. Patients bled a median of 300 mL during surgery. One patient bled 1830 mL, while the remaining patients bled ≤1000 mL. Blood transfusions were administered to 14 (16%) patients. Median platelet aggregation was within the reference ranges at all time points. Platelet aggregation increased during surgery and normalised within 24 h. ROTEM® analyses showed no perioperative significantly decrease of clot formation or clot strength. Routine coagulation parameters were overall normal. Conclusions: Severe perioperative bleeding was rare, and transfusions of blood products were used sparingly. Patients undergoing oesophagectomy due to cancer had an intact haemostasis with no sign of impaired haemostasis. Clinical trial registration: The trial was registered prior to initiation at www.clinicaltrials.gov (identification number NCT05067153).

AB - Background: Oesophagectomy is a major oncological surgical procedure. Previous studies have shown a wide range of bleeding during and after surgery, and it is unknown if perioperative bleeding associated with oesophagectomy is purely surgical in nature, or if it is exacerbated by impaired haemostasis. We aimed to perform a detailed investigation of the perioperative coagulation in patients undergoing oesophagectomy due to cancer. Methods: The study was a prospective study including adult patients with adeno- or squamous cell carcinoma referred for intended curative oesophagectomy. Operative bleeding volume and blood transfusions were recorded. Blood samples were collected at three timepoints: before, at the end of surgery, and on postoperative day one. Dynamic global haemostasis was investigated employing thromboelastometry (ROTEM®). Platelet aggregation was analysed with a Multiplate Analyzer®, and routine coagulation parameters were analysed. Results: We included 87 patients. Patients bled a median of 300 mL during surgery. One patient bled 1830 mL, while the remaining patients bled ≤1000 mL. Blood transfusions were administered to 14 (16%) patients. Median platelet aggregation was within the reference ranges at all time points. Platelet aggregation increased during surgery and normalised within 24 h. ROTEM® analyses showed no perioperative significantly decrease of clot formation or clot strength. Routine coagulation parameters were overall normal. Conclusions: Severe perioperative bleeding was rare, and transfusions of blood products were used sparingly. Patients undergoing oesophagectomy due to cancer had an intact haemostasis with no sign of impaired haemostasis. Clinical trial registration: The trial was registered prior to initiation at www.clinicaltrials.gov (identification number NCT05067153).

KW - haemostasis

KW - oesophageal neoplasms

KW - oesophagectomy

KW - platelet aggregation

KW - thromboelastography

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U2 - 10.1177/10760296251327587

DO - 10.1177/10760296251327587

M3 - Journal article

C2 - 40095681

AN - SCOPUS:105000428428

SN - 1076-0296

VL - 31

JO - Clinical and Applied Thrombosis/Hemostasis

JF - Clinical and Applied Thrombosis/Hemostasis

ER -

Patients Undergoing Oesophageal Cancer Surgery Do Not Have Impaired Haemostasis

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