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Preoperative Cardiac Risk Assessment and Surgical Outcomes of Patients with Gastric Cancer

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the incidence of major adverse cardiac events (MACE) and long-term surgical outcomes after gastrectomy for gastric cancer using the revised cardiac risk index (RCRI), which is based on preoperative insulin use, serum creatinine >2.0 mg/dL, and history of ischemic or congestive heart failure or cerebrovascular disease.

Methods

We allocated 1000 patients who underwent elective gastrectomy to three groups with ≥3 (group A, n = 32), 2 (group B, n = 142), or 1 (group C, n = 826) of these factors and compared surgical complications and prognoses.

Results

Groups A and B had older patients than group C. Group B had more male patients than groups A and C. Tumor staging and gastrectomy type were similar among all groups. D1 lymph node dissection was more frequent in group A than in groups B or C. The incidence of MACE in groups A, B, and C was 25.0, 9.9, and 1.1 %, respectively. RCRI was associated with MACE. Furthermore, the incidence of pneumonia and in-hospital mortality was associated with RCRI risk factors. However, the incidence of anastomotic leakage, intra-abdominal abscess, wound infection, and pancreas-related infection were similar among the groups. The 5-year overall survival rates of the three groups were 44.3, 65.2, and 80.8 %, which were significantly different.

Conclusions

Patients with RCRI factors have an increased risk of MACE, pneumonia, and higher mortality after gastrectomy; thus, careful patient selection and meticulous perioperative care are crucial for successful gastrectomy.

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References

  1. Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin. 2005;55:74–108.

    Article  PubMed  Google Scholar 

  2. Matsuda T, Marugame T, Kamo K, Katanoda K, Ajiki W, Sobue T; Japan Cancer Surveillance Research Group. Cancer incidence and incidence rates in Japan in 2006: based on data from 15 population-based cancer registries in the monitoring of cancer incidence in Japan (MCIJ) project. Jpn J Clin Oncol. 2012;42:139–47.

    Article  PubMed  Google Scholar 

  3. Bartlett EK, Roses RE, Kelz RR, Drebin JA, Fraker DL, Karakousis GC. Morbidity and mortality after total gastrectomy for gastric malignancy using the American College of Surgeons National Surgical Quality Improvement Program database. Surgery. 2014;156:298–304.

    Article  PubMed  Google Scholar 

  4. Watanabe M, Miyata H, Gotoh M, et al. Total gastrectomy risk model: data from 20,011 Japanese patients in a nationwide Internet-based database. Ann Surg. 2014;260:1034–9.

    Article  PubMed  Google Scholar 

  5. Grossmann EM, Longo WE, Virgo KS, et al. Morbidity and mortality of gastrectomy for cancer in Department of Veterans Affairs medical centers. Surgery. 2002;131:484–90.

    Article  PubMed  Google Scholar 

  6. Lee TH, Marcantonio ER, Mangione CM, et al. Derivation and prospective validation of a simple index for prediction of cardiac risk of major noncardiac surgery. Circulation. 1999;100:1043–9.

    Article  CAS  PubMed  Google Scholar 

  7. Fleisher LA, Beckman JA, Brown KA, et al. ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines on Perioperative Cardiovascular Evaluation for Noncardiac Surgery): developed in collaboration with the American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Rhythm Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, and Society for Vascular Surgery. Circulation. 2007;116:e418–99.

    Article  PubMed  Google Scholar 

  8. Sakuramoto S, Kikuchi S, Futawatari N, et al. Laparoscopy-assisted pancreas- and spleen-preserving total gastrectomy for gastric cancer as compared with open total gastrectomy. Surg Endosc. 2009;23:2416–23.

    Article  PubMed  Google Scholar 

  9. Lacy AM, Garcia-Valdecasas JC, Delgado S, et al. Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet. 2002;359:2224–9.

    Article  PubMed  Google Scholar 

  10. Hawn MT, Graham LA, Richman JS, Itani KM, Henderson WG, Maddox TM. Risk of major adverse cardiac events following noncardiac surgery in patients with coronary stents. JAMA. 2013;310:1462–72.

    Article  CAS  PubMed  Google Scholar 

  11. Bertges DJ, Goodney PP, Zhao Y, et al. The Vascular Study Group of New England Cardiac Risk Index (VSG-CRI) predicts cardiac complications more accurately than the revised cardiac risk index in vascular surgery patients. J Vasc Surg. 2010;52:674–83, 83 e1–83 e3.

  12. Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer. 2011;14:101–12.

    Article  Google Scholar 

  13. Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer. 2011;14:113–23.

    Article  Google Scholar 

  14. Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250:187–96.

    Article  PubMed  Google Scholar 

  15. Devereaux PJ, Mrkobrada M, Sessler DI, et al. Aspirin in patients undergoing noncardiac surgery. N Engl J Med. 2014;370:1494–503.

    Article  CAS  PubMed  Google Scholar 

  16. Ueshima H. Explanation for the Japanese paradox: prevention of increase in coronary heart disease and reduction in stroke. J Atheroscler Thromb. 2007;14:278–86.

    Article  PubMed  Google Scholar 

  17. Devereaux PJ, Xavier D, Pogue J, et al. Characteristics and short-term prognosis of perioperative myocardial infarction in patients undergoing noncardiac surgery: a cohort study. Ann Intern Med. 2011;154:523–8.

    Article  CAS  PubMed  Google Scholar 

  18. Chan J, Knutsen SF, Blix GG, Lee JW, Fraser GE. Water, other fluids, and fatal coronary heart disease: the Adventist Health study. Am J Epidemiol. 2002;155:827–33.

    Article  PubMed  Google Scholar 

  19. Sheer AJ, Heckman JE, Schneider EB, et al. Congestive heart failure and chronic obstructive pulmonary disease predict poor surgical outcomes in older adults undergoing elective diverticulitis surgery. Dis Colon Rectum. 2011;54:1430–7.

    Article  PubMed  Google Scholar 

  20. Jeong SH, Ahn HS, Yoo MW, et al. Increased morbidity rates in patients with heart disease or chronic liver disease following radical gastric surgery. J Surg Oncol. 2010;101:200–4.

    PubMed  Google Scholar 

  21. Matsumoto S, Takayama T, Wakatsuki K, Tanaka T, Migita K, Nakajima Y. Short-term and long-term outcomes after gastrectomy for gastric cancer in patients with chronic kidney disease. World J Surg. 2014;38:1453–60.

    Article  PubMed  Google Scholar 

  22. Marumo K, Homma S, Fukuchi Y. Postgastrectomy aspiration pneumonia. Chest. 1995;107:453–6.

    Article  CAS  PubMed  Google Scholar 

  23. Oprea AD, Popescu WM. Perioperative management of antiplatelet therapy. Br J Anaesth. 2013;111(Suppl 1):i3–17.

    Article  PubMed  Google Scholar 

  24. POISE Study Group. Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial. Lancet. 2008;371:1839–47.

    Article  Google Scholar 

  25. Kristensen SD, Knuuti J, Saraste A, et al. 2014 ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment and management: The Joint Task Force on non-cardiac surgery: cardiovascular assessment and management of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA). Eur Heart J. 2014;35:2383–431.

    Article  PubMed  Google Scholar 

  26. Shiba N, Shimokawa H. Chronic heart failure in Japan: implications of the CHART studies. Vasc Health Risk Manag. 2008;4:103–13.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Saito M, Fukami K, Hiramori K, et al. Long-term prognosis of patients with acute myocardial infarction: is mortality and morbidity as low as the incidence of ischemic heart disease in Japan. Am Heart J. 1987;113:891–7.

    Article  CAS  PubMed  Google Scholar 

  28. Cigolle CT, Kabeto MU, Lee PG, Blaum CS. Clinical complexity and mortality in middle-aged and older adults with diabetes. J Gerontol A Biol Sci Med Sci. 2012;67:1313–20.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Jones SB, Sen S, Lakshminarayan K, Rosamond WD. Poststroke outcomes vary by pathogenic stroke subtype in the Atherosclerosis Risk in Communities study. Stroke. 2013;44:2307–10.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Hemmelgarn BR, Manns BJ, Lloyd A, et al. Relation between kidney function, proteinuria, and adverse outcomes. JAMA. 2010;303:423–9.

    Article  CAS  PubMed  Google Scholar 

  31. Lee YH, Han SJ, Kim HC, et al. Gastrectomy for early gastric cancer is associated with decreased cardiovascular mortality in association with postsurgical metabolic changes. Ann Surg Oncol. 2013;20:1250–7.

    Article  PubMed  Google Scholar 

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Disclosure

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Department of Surgery, Nara Medical University School of Medicine, Kashihara, Nara, Japan

    Sohei Matsumoto MD, PhD, Tomoyoshi Takayama MD, PhD, Kohei Wakatsuki MD, PhD, Tetsuya Tanaka MD, PhD, Kazuhiro Migita MD, PhD, Masahiro Ito MD, Hiroshi Nakade MD, Tomohiro Kunishige MD & Yoshiyuki Nakajima MD, PhD

Authors
  1. Sohei Matsumoto MD, PhD
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  2. Tomoyoshi Takayama MD, PhD
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  3. Kohei Wakatsuki MD, PhD
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  4. Tetsuya Tanaka MD, PhD
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  5. Kazuhiro Migita MD, PhD
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  6. Masahiro Ito MD
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  7. Hiroshi Nakade MD
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  8. Tomohiro Kunishige MD
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  9. Yoshiyuki Nakajima MD, PhD
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Corresponding author

Correspondence to Sohei Matsumoto MD, PhD.

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Matsumoto, S., Takayama, T., Wakatsuki, K. et al. Preoperative Cardiac Risk Assessment and Surgical Outcomes of Patients with Gastric Cancer. Ann Surg Oncol 23 (Suppl 2), 222–229 (2016). https://doi.org/10.1245/s10434-015-4464-9

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  • DOI: https://doi.org/10.1245/s10434-015-4464-9

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