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 ® ). 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).