Objective:We investigated the relationship between venous thromboembolism (VTE) and pelvic and para-aortic lymphadenectomy (LND) within the first 90 days post gynaecological cancer surgery.Methods:A retrospective cohort analysis was conducted on 1021 patients who underwent gynaecological cancer surgery between 2006 and 2019. Univariate and multivariate analysis was performed to assess the effects of LND and lymph node (LN) metastasis on VTE occurrence within 90 days post-surgery.Results:A total of 41 patients developed VTE within 90 days post-surgery. Para-aortic LND was significantly associated with VTE (p< 0.001), with the highest rates (14.6%) observed in patients who had >10 para-aortic LN removed. In patients with pelvic LN metastasis, 10 (7.5%) developed VTE; patients with >5 pelvic nodes positive for metastasis had an HR = 4.83 (95% CI: 0.99–13.9) after adjustment for age, duration of hospital stay, and surgical approach. The highest VTE rates (27.3%) occurred in patients with >5 para-aortic LN positive for metastasis, HR = 3.79 (95% CI 1.44–14.23) after adjustment for age, duration of hospital stay, and surgical approach (p= 0.011).Conclusions:Para-aortic LND significantly increases VTE risk within the first 90 days post-surgery. The risk is further amplified in cases with metastatic LN and persists even after adjustment for other risk factors for VTE. While extended thromboprophylaxis is standard for all cancer patients, our findings suggest that para-aortic LND—especially with nodal metastases—may help identify those who would benefit most from a more tailored, risk-based prophylaxis approach.
目的：本研究旨在探讨妇科癌症术后90天内静脉血栓栓塞症（VTE）与盆腔及腹主动脉旁淋巴结清扫术（LND）之间的关联。 方法：对2006年至2019年间接受妇科癌症手术的1021例患者进行回顾性队列分析。通过单因素及多因素分析评估淋巴结清扫及淋巴结转移对术后90天内VTE发生的影响。 结果：术后90天内共有41例患者发生VTE。腹主动脉旁淋巴结清扫与VTE显著相关（p<0.001），其中清扫淋巴结数量>10枚的患者VTE发生率最高（14.6%）。在盆腔淋巴结转移患者中，10例（7.5%）发生VTE；经年龄、住院时间及手术方式校正后，盆腔转移淋巴结>5枚的患者风险比（HR）为4.83（95% CI：0.99–13.9）。腹主动脉旁转移淋巴结>5枚的患者VTE发生率最高（27.3%），经年龄、住院时间及手术方式校正后HR为3.79（95% CI 1.44–14.23）（p=0.011）。 结论：腹主动脉旁淋巴结清扫显著增加术后90天内的VTE风险。若存在淋巴结转移，该风险进一步升高，且在校正其他VTE危险因素后仍持续存在。尽管延长血栓预防是所有癌症患者的标准方案，但本研究提示腹主动脉旁淋巴结清扫（尤其伴有淋巴结转移）可能有助于识别哪些患者能从更具针对性、基于风险分层的预防策略中获益最多。
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