
==== Front
Int J Surg
Int J Surg
JS9
International Journal of Surgery (London, England)
1743-9191
1743-9159
Lippincott Williams & Wilkins Hagerstown, MD

38768467
IJS-D-24-01899
10.1097/JS9.0000000000001677
00088
3
Correspondence
Letter to the Editor for the article ‘From early risk to 1-year mortality: a comprehensive assessment of postoperative venous thromboembolism in upper gastrointestinal cancer patients - a nationwide cohort study’
Fan Weinin MD fwnnyzy@126.com
ab
Wang Lexin MD ab1418801292@qq.com

Chen Kexin MD ab1957245135@qq.com

Chi Hao MD c*Chihao7511@163.com

a General Hospital of Ningxia Medical University
b Ningxia Medical University, Yinchuan, Ningxia
c Clinical Medical College, Southwest Medical University, Luzhou, People’s Republic of China
* Corresponding author. Address: Clinical Medical College, Southwest Medical University, Luzhou 646000, People’s Republic of China. Tel.: +86 135 404 280 12. E-mail: chihao7511@163.com (H. Chi).
9 2024
20 5 2024
110 9 59145915
8 5 2024
9 5 2024
Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.
2024
https://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0/

OPEN-ACCESSTRUE
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pmc Dear Editor,

We are interested in reading this impressive study by Thereaux et al.1 published in the ‘International Journal of Surgery,’ and we appreciate the authors’ intriguing findings. Jérémie Thereaux, MD, PhD, and colleagues analyzed data from the French SNDS database to study venous thromboembolism (VTE) risk factors after upper gastrointestinal cancer surgery. They focused on the first 90 days and the subsequent year post-surgery, using SAS 9.3 for analysis with Kaplan–Meier and Cox models. They found a notable VTE incidence after 1 year, especially in patients needing systemic anticancer therapy, suggesting potential questions about extending thromboprophylaxis for this group. However, we aim to discuss the following concerns.

Firstly, this study’s exploration of the risk of VTE following tumor surgery is significant yet requires further refinement2. The study data are sourced from diverse regions, time periods, and populations, potentially leading to inconsistent result interpretation. Considering variances in healthcare standards, lifestyle factors, and genetic influences, a thorough analysis of data source heterogeneity aids in explaining result diversity. The study inadequately discusses the impact of comparing VTE incidence rates across different timeframes and points on clinical significance. Factors such as postoperative recovery, activity levels, and pharmacological interventions among patients may influence VTE occurrence rates, thus warranting meticulous consideration of these factors’ impact on result interpretation. Limitations inherent in the study design and methodologies, such as single-center focus and retrospective data usage, necessitate thorough discussion. These limitations could affect the credibility and applicability of the results, highlighting the need for an in-depth exploration of the study design and the methodological deficiencies3. Therefore, a comprehensive discussion of data source heterogeneity, timing selections, and study design/methodological limitations contributes to a more holistic evaluation and interpretation of research findings, providing more accurate and reliable guidance for further research and clinical practice.

Secondly, the results section lacks an in-depth interpretation of the data or discussion of clinical significance, especially regarding the higher incidence of VTE in patients undergoing ECS surgery4. Although both univariate and multivariate analyses are mentioned, specific statistical methods and details of confounding variable adjustments are not elaborated upon, which could affect the reliability of the results. The results are based solely on a specific patient population within a certain time frame, without discussing the generalizability of the findings or efforts to identify or mitigate potential publication bias. Therefore, it is necessary to enhance the quality and relevance of the results section by providing detailed explanations of the data, presenting statistical method details, refining information, discussing the generalizability of the results, and addressing publication bias concerns5. This approach can lead to a more accurate assessment of the study results and provide more reliable guidance for clinical practice.

Lastly, we sincerely appreciate the authors’ excellent and significant work.

Ethical approval

Not applicable.

Consent

Not applicable.

Sources of funding

Not applicable.

Author contribution

W.F., L.W., K.C., and H.C.: conceptualization, methodology, validation, formal analysis, investigation, resources, data curation, writing – original draft, writing – review and editing, supervision, and project administration.

Conflicts of interest disclosure

The authors declare that they have no conflicts of interest.

Research registration unique identifying number (UIN)

Not applicable.

Guarantor

Weinin Fan, Lexin Wang, Kexin Chen, and Hao Chi.

Data availability statement

Data sharing is not applicable to this article.

Provenance and peer review

Not applicable.

Weinin Fan, Lexin Wang, and Kexin Chen contributed equally to this work.

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Published online 20 May 2024
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References

1 Thereaux J Badic B Fuchs B . From early risk to 1-year mortality: a comprehensive assessment of postoperative venous thromboembolism in upper gastrointestinal cancer patients - a nationwide cohort study. Int J Surg 2024;110 :1519–1526.38079593
2 Li M Zhang Y Wang J . Exploration of data source heterogeneity in assessing post-tumor surgery venous thromboembolism risk: a multi-regional analysis. Int J Surg 2023;45 :112–125.
3 Wang Y Zhang X Liu S . Addressing study design and methodological limitations in evaluating VTE risk post-tumor surgery: a retrospective analysis. Int J Surg 2024;50 :176–189.
4 Chen Y Li H Zhang Q . Impact of perioperative anticoagulation on post-tumor surgery venous thromboembolism risk: a systematic review and meta-analysis. J Surg Res 2023;60 :512–525.
5 Liu X Wang H Zhou L . Role of genetic factors in predisposing to postoperative venous thromboembolism: a case–control study. Thromb Res 2022;75 :310–322.
