Does Synchronous Liver Intervention Increase Risk of Venous Thromboembolism in Patients with Metastatic Small-Bowel and Pancreatic Neuroendocrine Tumors?

INTRODUCTION: Previous literature suggests a higher incidence of venous thromboembolism (VTE) in patients with pancreatic neuroendocrine tumor (PNET) but no other gastrointestinal NET. In this study, we analyze the incidence of VTE in patients with metastatic small-bowel neuroendocrine tumors (SBNETs) and PNET undergoing synchronous liver procedures to determine whether these patients require extended VTE prophylaxis. METHODS: The American College of Surgeons NSQIP database was queried from 2008 to 2019 for patients undergoing operation for SBNET, PNET, benign small bowel, and pancreatic pathology. Patients with SBNET and PNET were stratified by additional operative procedures for liver metastasis (LM). The rate of 30-day postoperative VTE (pulmonary embolism [PE] and/or deep vein thrombosis [DVT]) was compared. Pearson’s chi-square and ANOVA tests were used for analysis. RESULTS: A total of 89,054 patients met inclusion criteria (63,396 benign small bowel, 3,073 SBNET, including 918 with LM, 18,724 benign pancreas, 3,861 PNET including 949 with LM). There was no statistically significant difference in the rate of VTE in patients with small-bowel disease with or without LM. Patients in the PNET with LM group had a significantly higher rate of PE but not DVT than those undergoing pancreatic operation for benign pathology (2.4% vs 1.1%; p < 0.001). Total operation time (odds ratio [OR] 1.002; p = 0.002), length of hospital stay (OR 1.027; p < 0.001), and preoperative dialysis (OR 3.779; p = 0.004) were independently associated with VTE. However, synchronous liver intervention was not an independent factor associated with VTE or PE in patients with PNET (Table 1). Table 1. - Rates of DVT and PE in Patients with PNETs and SBNETs Undergoing Synchronous Liver Procedures Group Total Rate of DVT Rate of PE Benign small-bowel procedures 63,396 987 (1.6%) 398 (0.6%) Procedures for SBNETs 2,155 26 (1.2%) 11 (0.5%) SBNETs with synchronous liver procedures 918 12 (1.3%) 9 (1.0%) Benign pancreas procedures 18,724 400 (2.1%) 203 (1.1%) Procedures for PNETs 2,912 59 (2.0%) 44 (1.5%) PNETs with synchronous liver procedures 949 18 (1.9%) 23 (2.4%) CONCLUSION: Synchronous liver intervention does not increase the risk of VTE in patients with metastatic SBNET or PNET.