Annals of Coloproctology

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Original Article

ERAS

Predicting venous thromboembolism and determining appropriate prophylaxis in elderly patients undergoing colorectal cancer surgery with Enhanced Recovery After Surgery (ERAS) using the adjusted Caprini score: Young Sun Choi, Hyung Jin Cho, Chul Seung Lee, Dong Geun Lee, Choon Sik Chung, Gwan Cheol Lee, Dong Woo Kang, Jeong Sub Kim, Tae Gyu Kim; Ann Coloproctol. 2025;41(4):279-286. Published online August 26, 2025; DOI: https://doi.org/10.3393/ac.2024.00857.0122

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Abstract PDF Supplementary Material: Purpose
Age and postoperative complications are known risk factors for venous thromboembolism (VTE). Minimally invasive surgery and Enhanced Recovery After Surgery (ERAS) protocol has been implemented to reduce these risks. The purpose of this study was to assess the short- and long-term effects of a VTE prophylaxis program using the Caprini score in elderly patients undergoing minimally invasive colorectal cancer surgery with the ERAS protocol.
Methods
This retrospective cross-sectional study included 1,043 colorectal cancer patients requiring surgery from January 2017 to December 2019, divided into a control group (≤75 years) and an elderly group (>75 years), with 827 and 216 patients, respectively. The primary outcome was the incidence of VTE; secondary outcome was the incidence of postoperative complications, particularly bleeding.
Results
The incidence of VTE was 1.5% in the control group and 3.7% in the elderly group (P=0.061). Five patients (0.5%) experienced symptomatic VTE, and the Caprini score for all VTE patients was ≤8 points; thus, only mechanical prophylaxis was used. In the multivariable logistic regression, the Caprini score (P=0.024) and cancer stage (P=0.004) were selected. The odds ratios (95% confidence interval) of the Caprini score and TNM staging were 1.758 (1.078–2.867) and 6.152 (2.045–26.510), respectively.
Conclusion
When the ERAS protocol was used for patients with colorectal cancer as perioperative care, the VTE risk was lower than that estimated by the Caprini score. Given that age is a recognized risk factor for major bleeding, criteria for the use of anticoagulation to prevent VTE, particularly in elderly patients, should be carefully evaluated, considering both the bleeding risks and the potential benefits of pharmacologic prophylaxis. Trial registration: Clinical Research Information Service (CRIS; cris.nih.go.kr) identifier: KCT0007804

Review

ERAS

Venous thromboembolism among Asian populations with localized colorectal cancer undergoing curative resection: is pharmacological thromboprophylaxis required? A systematic review and meta-analysis: Shih Jia Janice Tan, Emile Kwong-Wei Tan, Yvonne Ying Ru Ng, Rehena Sultana, John Carson Allen, Isaac Seow-En, Ronnie Mathew, Aik Yong Chok; Ann Coloproctol. 2024;40(3):200-209. Published online May 16, 2024; DOI: https://doi.org/10.3393/ac.2022.01046.0149

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Purpose
We compared the incidence of venous thromboembolism (VTE) among Asian populations with localized colorectal cancer undergoing curative resection with and without the use of pharmacological thromboprophylaxis (PTP).
Methods
A comprehensive literature search was undertaken to identify relevant studies published from January 1, 1980 to February 28, 2022. The inclusion criteria were patients who underwent primary tumor resection for localized nonmetastatic colorectal cancer; an Asian population or studies conducted in an Asian country; randomized controlled trials, case-control studies, or cohort studies; and the incidence of symptomatic VTE, deep vein thrombosis, and/or pulmonary embolism as the primary study outcomes. Data were pooled using a random-effects model. This study was registered in PROSPERO on October 11, 2020 (No. CRD42020206793).
Results
Seven studies (2 randomized controlled trials and 5 observational cohort studies) were included, encompassing 5,302 patients. The overall incidence of VTE was 1.4%. The use of PTP did not significantly reduce overall VTE incidence: 1.1% (95% confidence interval [CI], 0%–3.1%) versus 1.9% (95% CI, 0.3%–4.4%; P = 0.55). Similarly, PTP was not associated with significantly lower rates of symptomatic VTE, proximal deep vein thrombosis, or pulmonary embolism.
Conclusion
The benefit of PTP in reducing VTE incidence among Asian patients undergoing curative resection for localized colorectal cancer has not been clearly established. The decision to administer PTP should be evaluated on a case-bycase basis and with consideration of associated bleeding risks.

Citations

Citations to this article as recorded by

Effectiveness and Safety of Long-Term Venous Thromboembolism Prophylaxis After Colorectal Cancer Surgery: A Retrospective Study
Ying Zhang, Xiaozhu Zhou, Yi Wu, Shicai Chen, Xiangli Cui, Ying Zhao
Drugs - Real World Outcomes.2025; 12(3): 479. CrossRef

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