Leonard G. Gomella, MD, presented “Thromboembolic Complications in Bladder Cancer” during the 3rd Annual International Bladder Cancer Update on January 23, 2019 in Beaver Creek, Colorado.

How to cite: Gomella, Leonard G. “Thromboembolic Complications in Bladder Cancer” January 23, 2019. Accessed Mar 2024. https://grandroundsinurology.com/thromboembolic-complications-in-bladder-cancer-2/

Thromboembolic Complications in Bladder Cancer – Summary:

Leonard G. Gomella, MD, FACS, discusses the highly thrombogenic nature of bladder cancer and the burden of thromboembolic complications in patients undergoing radical cystectomy. He then reviews optimal methods and duration of prophylaxis to reduce the risk of these complications.

Abstract:

Radical cystectomy is a complex, extirpated operation that violates two organ systems. The procedure has alarming rates of complications and 90-day mortality, readmissions, and costs. Furthermore, there have been no significant changes in rate, type of, or severity of 30-day  radical cystectomy-related since 2010.

Of these complications, bladder cancer patients are particularly susceptible to thrombogenic events due to disease-related factors that induce hypercoagulability, common bladder cancer patient characteristics, and consequences of treatments. Because of these factors, cystectomy ranks second in the incidence of deep venous thrombosis (DVT) and venous thromboembolism (VTE) among commonly performed cancer operations. It also ranks first in pulmonary embolism (PE).

Evidence shows that the use of robotic robot-assisted radical cystectomy rather than open radical cystectomy leads to little improvement rates of PE and VTE complications. Similarly, studies have shown little benefit to using Enhanced Recovery After Surgery (ERAS) protocols in radical cystectomy complications. However, methods that could decrease the risk of these complications include perioperative chemoprophylaxis and compression boots, early ambulation, and extending DVT prophylaxis beyond patient discharge. Options for perioperative parenteral anticoagulation include unfractionated heparin and low molecular weight heparins.

This presentation discusses safety, efficacy, and cost of extended prophylaxis, as well as optimal duration of VTE prophylaxis, specifically if it should extend longer than 4 weeks post-cystectomy. The conversation also covers the risk of arterial thromboembolism (ATE) in patients undergoing cystectomy, and the impact of neoadjuvant chemotherapy on thromboembolic events.

About the International Bladder Cancer Update

The International Bladder Cancer Update (IBCU) is an annual one-day CME conference focused on bladder cancer treatment updates. IBCU takes place during its sister conference, the International Prostate Cancer Update (IPCU). The conference’s faculty consists of international experts, and the event caters to urologists, urologic oncologists, and other healthcare professionals. In addition to didactic lectures, IBCU features interactive discussions, a panel roundtable, debates, and case presentations. Dr. Gomella presented this lecture during the 3rd IBCU in 2019. Please visit this page in order to learn more about future IBCU meetings.