Risk for deep venous thrombosis in pediatric cancer patients undergoing surgery.

PURPOSE: Cancer is a well-established risk factor for deep venous thrombosis (DVT). We sought to assess the incidence of DVT in pediatric cancer patients undergoing select surgical procedures at our institution and to identify additional factors associated with DVT development. METHODS: We performed a retrospective review of cancer patients who underwent select surgical procedures and developed a DVT within 30 days of their operation from 2000 to 2018 at our institution. Catheter-associated DVTs were excluded from this analysis. Major oncologic operations were selected. RESULTS: From 2000 to 2018, 3031 major oncologic operations were performed following which 14 symptomatic DVTs occurred, for an overall incidence of 0.46%. Procedures associated with post-operative DVT included: mass biopsy (7), pulmonary wedge resection (2), inguinal lymph node excision (1), colectomy (1), nephrectomy (1), lower extremity limb-sparing revision (1), and femur resection (1). CONCLUSIONS: Our data suggest that surgery does not put children with cancer at significant risk for DVT. Given the low incidence of perioperative DVT, routine pharmacologic prophylaxis for children with cancer undergoing surgery does not seem warranted. LEVEL OF EVIDENCE: II.

Role of Amputation in Improving Mobility, Pain Outcomes, and Emotional and Psychological Well-Being in Children With Metastatic Osteosarcoma.

BACKGROUND:: Few studies have analyzed the benefit of limb amputations in children with metastatic osteosarcoma and limited life span. OBJECTIVE:: We studied outcomes of limb amputations in children with metastatic osteosarcoma. DESIGN:: We performed a retrospective review of patients who underwent limb amputations (January 1995-June 2015) and died within 1 year of surgery. SETTING/PARTICIPANTS:: We studied 12 patients with osteosarcoma at a single institution. MEASUREMENTS:: Data on mobility, pain, and emotional and psychological well-being were retrieved from medical records from 1 month before surgery to 6 months after surgery. RESULTS:: Of the 12 patients (7 females and 5 males; median age at surgery 13 years [range, 7-20 years]) meeting study criteria, 3 patients and 9 patients had primary osteosarcoma in upper and lower limbs, respectively. Mobility improved postamputation in 8 bedridden/wheelchair-bound patients. Postamputation, emotional, and psychological well-being improved for 9 patients, 3 patients had persistent psychological and/or emotional symptoms, and no patient experienced signs of regret. Daily mean pain scores were significantly lower at 1 week (median 3 [range, 0-6]; P = .03) and 3 months (median 0 [range, 0-8]; P = .02) postsurgery than at 1 week presurgery (median 5.5 [range, 0-10]). Morphine consumption (mg/kg/d) showed a trend toward higher values at 1 week (median 0.2 [range, 0-7.6]; P = .6) and 3 months (median 0.2 [range, 0-0.5]; P = .3) postsurgery than at 1 week presurgery (median 0.1 [range, 0-0.5]). CONCLUSIONS:: Patients undergoing limb amputations had reduced pain and improved mobility and emotional and psychological well-being. Amputations are likely to benefit children with limited life expectancy.