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Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet].

Thromboembolism during neoadjuvant therapy for rectal cancer: a systematic review

Review published: 2013.

Bibliographic details: Smart PJ, Burbury KL, Lynch AC, Mackay JR, Heriot AG.  Thromboembolism during neoadjuvant therapy for rectal cancer: a systematic review. Colorectal Disease 2013; 15(9): e496-e502. [PubMed: 23910015]


AIM: Thromboembolism (TE) is a common, costly and morbid complication that is also associated with decreased survival in cancer patients. However, the risk of cancer-associated TE varies because of the multitude of patient-, cancer- and treatment-related influences. Thromboprophylaxis (TP) is currently not widely adopted in the ambulant population. A review of the literature was undertaken to determine the rate of TE and the benefit of TP in patients with rectal cancer during neoadjuvant therapy (nT).

METHOD: A systematic literature search of electronic databases, including PubMed and Embase, was performed (1995-2012) for all studies assessing nT in rectal cancer. Data were extracted and used to assess study design, patient demographic and clinical characteristics, treatment protocols and TE incidence. A systematic review was conducted to identify the rates of TE. The search strategy included text terms and MeSH headings for TP, rectal cancer and nT.

RESULTS: Twelve of 86 studies met quality criteria for reporting TE complications and described 10 pulmonary emboli and three deep-vein thromboses in 3375 patients (overall TE rate = 0.38%). Ninety per cent of pulmonary emboli reported were fatal, suggesting significant under-reporting of TE events, even in high-quality studies.

CONCLUSION: The risk of fatal pulmonary embolism in studies examining nT in rectal cancer that reported complications systematically was one in 375 (0.27%; 95% CI: 0.09-0.44%). The overall TE rate, as well as the effectiveness of TP during nT, remains unknown. TE events should be systematically reported using common terminology frameworks in cancer studies.

Colorectal Disease © 2013 The Association of Coloproctology of Great Britain and Ireland.

CRD has determined that this article meets the DARE scientific quality criteria for a systematic review.

Copyright © 2014 University of York.

PMID: 23910015

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