Deep Vein Thrombosis (DVT) constitutes a pathological condition wherein blood abnormally coagulates within the veins, leading to venous blockage and impaired venous return. The onset of this condition is marked by four principal manifestations: limb swelling, pain, elevated local skin temperature, and superficial vein varicosity. Such a condition may be precipitated by factors including trauma, surgery, neoplasms, and parturition (1), primarily affecting the iliac-femoral and femoral-carotid veins in the lower extremities. Postoperative DVT, typically manifesting within one month following surgical intervention, is precipitated by the surgical and traumatic stimuli. Research grounded in evidence-based medicine indicates that the incidence of postoperative DVT ranges between 42% and 57% in the absence of postoperative thromboprophylaxis. Advancements in surgical techniques, an enhanced understanding of DVT, and improvements in rehabilitative medical care have contributed to a gradual decline in the incidence of postoperative DVT. However, as a grave postoperative complication, DVT not only escalates treatment costs and hinders recovery but also poses the risk of pulmonary embolism—a dire and potentially fatal consequence—underscoring the necessity of its emphasis in clinical practice (2). Investigations have elucidated that DVT, as a prevalent postoperative complication among patients with gynecological surgery due to malignancies (3), significantly impedes the therapeutic process, prolongs hospitalization, diminishes life quality, and may precipitate pulmonary embolism, thus severely jeopardizing patient safety (4). Consequently, the prevention and mitigation of DVT's development in clinical settings are of paramount importance. This study endeavors to meticulously review and analyze literature from both domestic and international sources to analyze risk factors associated with DVT following gynecological surgery, so as to identify and assess the risk factors for DVT occurrence in gynecological postoperative patients, which provides a basis for prevention and control strategies.

Deep Vein Thrombosis (DVT) constitutes a pathological condition characterized by abnormal coagulation of blood within the veins, leading to venous obstruction and compromised venous return. This condition manifests through four primary symptoms: limb swelling, pain, an increase in local skin temperature, and superficial vein distension. DVT is noted for its significant morbidity and mortality rates, representing a prevalent and severe complication within the realm of gynecological oncology. The primary risk factors for DVT encompass surgical procedures, malignancy, and prolonged immobility, with gynecological surgeries posing a heightened risk due to specific anatomical considerations and distinctive characteristics (17), Consequently, the prompt and precise diagnosis, followed by standardized management of DVT by healthcare professionals, is imperative (18). Research indicates a marked difference in the incidence rates of postoperative DVT between patients with benign gynecological conditions (14%) and those afflicted by malignant tumors (38%). Furthermore, the mortality rate among patients diagnosed with DVT is reported to be up to sixfold higher than the baseline mortality rate (19). This evidence underscores the critical nature of DVT and highlights the necessity for its prevention and effective management in the clinical setting.

Virchow's triad posits that thrombosis is precipitated by three principal factors: endothelial injury, alterations in hemodynamics, and hypercoagulability of the blood. The abundance of pelvic blood vessels in women, coupled with the potential endothelial damage incurred during gynecological surgeries, sets the stage for vascular injury (20). This risk is further compounded by the prolonged bed rest post-surgery, leading to slowed blood flow and hemodynamic changes that favor the development of lower extremity deep vein thrombosis (DVT). Research has elucidated that the risk of lower extremity venous thrombosis in patients with malignant tumors is significantly elevated—ranging from two to seven times higher—compared to the general population (21).

Further studies affirm age as a critical risk factor for the formation of DVT, establishing a direct correlation between advancing age and the incidence of lower extremity DVT (22). Notably, DVT manifests with particular prevalence at three peak ages: 20–24, 45–59, and 70–74 years. The transition into the perimenopausal period, characterized by decreased hormone levels, reduced activity, and increased vascular fragility, escalates the risk of vascular injury and, subsequently, the incidence of DVT in older women (23). For each year of age, the risk of developing lower extremity venous thrombosis increases by a factor of 1.07 relative to the general populace (24). Obesity serves as both a predisposing and exacerbating factor for numerous health conditions (25). Studies have verified that individuals with a Body Mass Index (BMI) greater than 25 face a 1.3-fold increase in DVT risk compared to those of normal weight (26, 27). Experts contend that obesity fosters a pro-inflammatory state, wherein the resultant inflammation augments the production of pro-coagulant factors within the bloodstream, thereby facilitating the genesis and progression of DVT.

Plasma D-dimer serves as a highly sensitive biomarker for the prophylaxis of deep vein thrombosis (DVT) in the lower extremities. Nevertheless, its utility is frequently limited in clinical practice due to the fact that elevated D-dimer levels can result from a variety of conditions, including but not limited to, hepatic and renal dysfunctions, as well as atrial fibrillation. Furthermore, patients with gynecologic malignancies who experience prolonged durations of surgery and postoperative bed rest constitute additional risk factors for the development of DVT. This association is particularly significant given the direct correlation with the impairment of lower limb venous return. Specifically, the extended operative times exacerbate damage to patient's tissues and organs, thereby eliciting a more rapid and pronounced systemic stress response. Consequently, the incidence of venous thrombosis in the lower limbs is quadrupled in patients whose surgeries exceed one hour in duration, compared to those with gynecologic oncology procedures under one hour (28). Additionally, the presence of malignant tumors markedly elevates the risk of DVT, with the extent of thrombotic risk being intricately linked to both the type and stage of the tumor (29). A relevant study suggests that low molecular weight heparin (LMWH) and fondaparinux have demonstrated greater efficacy in preventing DVT in gynecologic cancer patients, and that direct oral anticoagulants (DOACs) can be used to prevent DVT in outpatients and high-risk medical patients post-discharge (30).

In this research, we conducted a comprehensive analysis of the contributory factors to the incidence of Deep Vein Thrombosis (DVT) post-gynecologic oncology surgeries, synthesizing data from twelve studies. This analysis encompassed six key risk factors, revealing that significant predictors for postoperative DVT in patients with gynecologic malignancies include age, Body Mass Index (BMI), D-dimer levels, surgery duration, and the length of postoperative bed rest. Furthermore, the included literature indicates that the occurrence of DVT in the lower extremities is predominantly concentrated within the first 1–10 days post-surgery.

This study represents an extensive and generalized examination, building upon prior analyses that considered multiple factors in isolation. It highlights the multifaceted nature of risk factors associated with postoperative DVT in patients undergoing treatment for gynecologic malignancies. Furthermore, it addresses the current clinical debates surrounding these risk factors, selecting contentious issues as focal points for investigation. Nonetheless, this study is not without its limitations. This study lacks the inclusion of relevant clinical parameters, as the original authors of the included literature did not consistently report specific cutoff values for variables such as age, body mass index, D-dimer levels, duration of surgery, and length of postoperative bed rest. Additionally, the available data in various studies were not uniformly categorized, and no clear threshold for the analysis of continuous variables was established, which may affect the validity of the study's results. The study exclusively relies on published literature, which may lead to an insufficient number of studies and sample sizes, coupled with an inherent risk of bias due to the retrospective nature of these studies. Moreover, the literature review was limited to Chinese publications, potentially omitting relevant studies and thereby constraining the comprehensiveness of the analysis. The risk of bias assessment for the included studies indicated a high risk of bias. Notably, the selected literature did not account for patients who experienced thrombus resolution in the preoperative period, introducing a potential selection bias. Consequently, there is a pressing need for corroborative studies with larger sample sizes to establish a more robust evidence base for clinical decision-making in the context of evidence-based medicine.