# Para-Aortic Lymph Node Dissection and Metastasis Increase the Rate of Postoperative VTE in Gynaecological Cancers

## TL;DR

This study shows that para-aortic lymph node dissection in gynecological cancer surgery increases the risk of blood clots, especially when more nodes are removed or metastases are present.

## Contribution

The study identifies para-aortic lymph node dissection and metastasis as significant risk factors for postoperative VTE in gynecological cancer patients.

## Key findings

- Para-aortic LND significantly increases the risk of VTE, especially when more than 10 nodes are removed.
- Patients with more than 5 para-aortic lymph nodes positive for metastasis had a 27.3% VTE rate.
- Pelvic LND was not associated with increased VTE risk, unlike para-aortic LND.

## Abstract

Cancer is associated with an increased risk of thrombosis; this is one of the main causes of mortality after cancer. Surgery is associated with increased VTE; this risk increases with the complexity of surgery. LND is part of gynaecology cancer surgery, involving mainly pelvic or para-aortic areas which add to the surgical complexity. We studied the effect of pelvic and para-aortic LND on the risk of VTE. We concluded that VTE is higher in gynaecological cancer patients following para-aortic LND, especially when more than 10 nodes were removed. Pelvic LND was not associated with an increased risk of VTE post cancer surgery. Para-aortic and pelvic LN metastasis status significantly increases the risk of postoperative VTE in gynaecological cancers. LN metastasis may be a potential predictive marker for postoperative VTE. These findings highlight the importance of thromboprophylaxis in gynaecology cancer patients’ post-surgery, especially in patients undergoing para-aortic LND.

Objective: We investigated the relationship between venous thromboembolism (VTE) and pelvic and para-aortic lymphadenectomy (LND) within the first 90 days post gynaecological cancer surgery. Methods: A retrospective cohort analysis was conducted on 1021 patients who underwent gynaecological cancer surgery between 2006 and 2019. Univariate and multivariate analysis was performed to assess the effects of LND and lymph node (LN) metastasis on VTE occurrence within 90 days post-surgery. Results: A total of 41 patients developed VTE within 90 days post-surgery. Para-aortic LND was significantly associated with VTE (p < 0.001), with the highest rates (14.6%) observed in patients who had >10 para-aortic LN removed. In patients with pelvic LN metastasis, 10 (7.5%) developed VTE; patients with >5 pelvic nodes positive for metastasis had an HR = 4.83 (95% CI: 0.99–13.9) after adjustment for age, duration of hospital stay, and surgical approach. The highest VTE rates (27.3%) occurred in patients with >5 para-aortic LN positive for metastasis, HR = 3.79 (95% CI 1.44–14.23) after adjustment for age, duration of hospital stay, and surgical approach (p = 0.011). Conclusions: Para-aortic LND significantly increases VTE risk within the first 90 days post-surgery. The risk is further amplified in cases with metastatic LN and persists even after adjustment for other risk factors for VTE. While extended thromboprophylaxis is standard for all cancer patients, our findings suggest that para-aortic LND—especially with nodal metastases—may help identify those who would benefit most from a more tailored, risk-based prophylaxis approach.