Determining the comparison of thrombogenic factors in patients with colorectal adenocarcinoma receiving laparoscopic or open surgery

Doctoral Dissertation uoadl:2887127 217 Read counter

Unit:
Faculty of Medicine
Library of the School of Health Sciences
Deposit date:
2019-12-09
Year:
2019
Author:
Christophides Thalis
Dissertation committee:
Μπράμης Ιωάννης, Ομότιμος Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Φίλης Κωνσταντίνος, Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ, Επιβλέπων
Γεωργόπουλος Σωτήριος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Ζωγράφος Γεώργιος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Τραυλού Ωραιάνθη, Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Μενενάκος Ευάγγελος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Θεοδώρου Δημήτριος, Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Original Title:
Προσδιορισμός της σύγκρισης θρομβογεννητικών παραγόντων σε ασθενείς μετά από λαπαροσκοπική ή ανοιχτή κολεκτομή για αδενοκαρκίνωμα του παχέος εντέρου
Languages:
Greek
Translated title:
Determining the comparison of thrombogenic factors in patients with colorectal adenocarcinoma receiving laparoscopic or open surgery
Summary:
The purpose of this study was to investigate the potential variation of two
thrombogenic biomarkers, the endogenous thrombin potential (ETP) and D-dimers,
in patients undergoing open or laparoscopic colectomy for colorectal cancer.
Thus we wanted to see whether these two factors under investigation may serve as
prognostic indicators for possible haemostatic alterations in patients with colorectal
cancer.
This prospective nonrandomized study was approved by the Scientific Committee
of Hippokration General Hospital, Athens/Greece and included 49 patients who
were divided into two groups according to the type of surgery they underwent.
The first group of patients N = 26 (Group A-OP) were subjected to open colectomy
and the second group of patients N = 23 (Group B-LS) underwent laparoscopic
colectomy. We measured the endogenous thrombin potential (ETP) and D-dimers
pre-operatively, at 24 hours post-operatively and the 10th postoperative day.
Comparing postoperative measurements of ETP with pre-operative values, we
found significant reduction at 24 hours and to a lesser extent but equally important,
on the 10th day postoperatively (p<0.001).
The type of surgery significantly affected the results since in 24 hours significantly
lower values were observed in group A (p = 0.035). Values were similar between
the two groups on the 10th postoperative day. Considering the values of D-dimers, there was a significant variation overtime (p = 0.001). Very high values were
observed in 24 hours and this was less pronounced in 10 days. The type of surgery
significantly affected the results, since in group A there were significantly higher
values both on 24h and on the 10th postoperative day (p <0.001).
The results related to ETP suggest that surgery generally affects haemostasis, since
the low ETP values may carry the risk of bleeding due to the consumption of
clotting factors. This effect was most prominent in group A (OS) compared to
Group B (LS), and this could mean that the laparoscopic technique is less
burdensome for the risk of bleeding.
As far as the D-dimers are concerned, the activation of the coagulation cascade in
conjunction with the inflammatory response to injury may be the etiologic factors
related to these fluctuations.
One of the important points of our study was the observation of D-dimer values in
relation to the surgical technique. Most probably, the reduced tissue injury in
laparoscopic surgery may protect against the risk of thrombosis. It is important that
this protection was extended until the 10th postoperative day as well. The
contribution of ETP measurement, which according to our knowlwdgw is taking
place for the first time in a surgery, in conjunction with D-dimers, may contribute
significantly to similar situations. It can be used in research studies as well for
better understanding of hemostasis in cancer patients. The measurement of ETP which is now automated can provide valuable information on the overall
hemostatic status of the patient, for the decision to initiate thromboprophylaxis
postoperatively, but also to determine the length of treatment. It would be also
highly interesting to combine and compare the ETP measurement with other
spherical hemostatic assays such as as thromboelastography throughout the surgical
procedure as well as postoperatively. The information that can be extracted from
such studies could help health care providers to "individualize" the prescription of
anticoagulant therapy in surgical patients. Determining the optimal dose of an
anticoagulant is of paramount importance that should take into account the global
picture of hemostasis and thus we think that could potentially reduce complications
such as bleeding or thrombosis.
Main subject category:
Health Sciences
Keywords:
Thrombosis and cancer, Endogenous thrombin potential (ETP), Colorectal cancer, Laparoscopic vs open colectomy
Index:
No
Number of index pages:
0
Contains images:
Yes
Number of references:
264
Number of pages:
161
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