Venous thromboembolism rates in patients with bone and soft tissue sarcoma of the extremities following surgical resection: A systematic review

J Surg Oncol. 2021 Sep;124(3):390-399. doi: 10.1002/jso.26499. Epub 2021 Apr 18.


Background: Patients undergoing an orthopedic surgery for bone or soft tissue sarcoma are at increased venous thromboembolism (VTE) risk. Unfortunately, there is a lack of thromboprophylaxis guidelines in this population. The purpose of this systematic review was to determine the soft tissue and bone sarcoma VTE rate and to explore the thromboprophylaxis regimens used.

Methods: The databases MEDLINE, EMBASE, and CENTRAL were queried using keywords related to VTE and long bone malignancy requiring surgical intervention to 2020. Included studied reported VTE rate in patients with surgically managed extremity sarcoma. Descriptive statistics and weighted mean totals were calculated.

Results: A total of 2082 studies were screened and 23 studies were included. The overall VTE rate was 2.9%, with a rate of 3.7% and 1.4% in patients with bone and soft tissue sarcomas, respectively. Low-molecular-weight heparin was the most commonly used chemoprophylaxis.

Conclusions: There is a high VTE rate following sarcoma surgery. The VTE rate is higher in bone sarcoma surgery, which may be attributed to differences in surgery and postoperative recovery. There was no consensus on the duration or type of thromboprophylaxis used. Future research is needed to determine the most effective thromboprophylaxis regimen in patients with sarcoma and whether individualized thromboprophylaxis is required.

Keywords: orthopedic oncology; sarcoma; thromboprophylaxis; venous thromboembolism.

Publication types

  • Systematic Review

MeSH terms

  • Bone Neoplasms / epidemiology
  • Bone Neoplasms / pathology
  • Bone Neoplasms / surgery*
  • Case-Control Studies
  • Extremities / pathology
  • Extremities / surgery
  • Humans
  • Observational Studies as Topic
  • Orthopedic Procedures / adverse effects
  • Orthopedic Procedures / statistics & numerical data*
  • Osteosarcoma / epidemiology
  • Osteosarcoma / pathology
  • Osteosarcoma / surgery*
  • Randomized Controlled Trials as Topic
  • Sarcoma / epidemiology
  • Sarcoma / surgery*
  • Soft Tissue Neoplasms / epidemiology
  • Soft Tissue Neoplasms / pathology
  • Soft Tissue Neoplasms / surgery*
  • Venous Thromboembolism / epidemiology*
  • Venous Thromboembolism / etiology