**2. Incidence**

DVT constitutes a major health problem, especially among the elderly. In comparison with previous era, the incidence of DVT remains the same among men and possibly increasing in elderly females (Silverstein et al., 1998). On the other hand, the incidence of PE is decreasing

Deep Venous Thrombosis After Radical Pelvic Surgery 175


tumor.


factor.


therapy






antithrombin III complexes . -Abnormalities of the platelets . -Tissue factor and cancer procoagulant -Factors that influence vascular endothelial permeability such as vascular endothelial growth



radiotherapy for cancer







plasminogen activation -Intravenous (IV) drug abuse -Acute medical illness -Inflammatory bowel disease -Myeloproliferative disorders






**Stasis:** -Immobilization.

**Vessel wall injury:** -Surgical trauma.

**General factors:** -Obesity

Table 1. Risk factors in DVT following radical pelvic surgeries

**Thrombophilia** -Factor V Leiden mutation.

over years (Silverstein et al., 1998). However, the incidence of DVT and PE may be underestimated because of the missed diagnosis, absence of pertinent symptoms or the absence of laws to permit routine autopsies in sudden post-operative mortalities in most centers (Dalen & Alpert, 1975; Clagett, 1994). Furthermore, unexplained DVT may be the first presentation in some malignancies, such as prostate, colorectal and bladder (Monreal & Prandoni, 1999).

In a series of 2373 patients, the incidence of DVT was 0.87% after urologic surgeries for prostate and bladder tumors, 2.8% in general surgery and 2% in gynecological surgeries (Scarpa etal., 2007).

The incidence of DVT may be as low 2% after radical cystectomy (Ali-El-Dein et al., 2008; Ghoneim et al., 2008), or as high as 40% following prolonged gynecological or obstetrical surgery (Walsh et al., 1974; Clarke-Pearson et al., 1983). Patients undergoing large bowel surgery also have a considerable risk of DVT and pulmonary embolism. The incidence of DVT following radical cystectomy in our hospital is 2% to 2.6% and PE following DVT or without prior DVT has long been a leading cause of post-operative death (Ali-El-Dein et al., 2008; Ghoneim et al., 2008). In patients undergoing surgery or radiotherapy for treatment of localized prostate cancer the incidence of DVT was 2% for pelvic lymphadenectomy alone and 1.9% following prostatectomy, while fatal PE occurred in 2 patients (3.7%) after prostatectomy (Bratt et al., 1994).

The incidence of DVT after gynecologic and obstetrical surgeries varies according to the presence or absence of the known risk factors among patients and according to the methods of diagnosis. It has been reported that this incidence is 14% after benign gynecological surgeries (Walsh et al., 1974), while the rate has been higher (38%) for patients undergoing surgery for gynecological tumors (Crandon & Knotts, 1983). In addition, among all causes of death following gynecologic surgeries, PE has been a leading cause of postoperative mortality in high risk women with gynecologic malignancy (Clarke-Pearson et al., 1983). Following laparoscopic radical hysterectomy for cervical carcinoma the incidence of DVT has been 3% (Chen et al., 2008).

In the study of yang et al. on 3645 patients undergoing surgery for colorectal cancer, 31 (0.85%) developed symptomatic venous thromboembolism or VTE (Yang et al., 2011).
