Gastrectomy for early gastric cancer is associated with decreased cardiovascular mortality in association with postsurgical metabolic changes.
BACKGROUND
Bariatric surgery effectively induces weight loss and resolves cardiovascular comorbidities in obese patients. We investigated cardiovascular and all-cause mortality in patients who underwent gastrectomies for early gastric cancer (EGC) and analyzed the changes in metabolic parameters after surgery.


METHODS
A total of 2,477 patients who underwent gastrectomies for EGC between 1995 and 2004 were enrolled in the study and followed for mortality through 2007. Standardized mortality ratios (SMRs) were calculated using sex- and age-matched mortality in the general Korean population in 2005. Effects of gastrectomy on changes in body weight and metabolic parameters were investigated in 51 of the patients before and after surgery.


RESULTS
During the 15,096.4 person-years of follow-up, 244 deaths were recorded. The all-cause mortality was not significantly different from that of the general population (SMR [95 % confidence interval (CI)] = 1.01 [0.89 - 1.14]); however, cardiovascular mortality was significantly lower (SMR = 0.35 [0.22 - 0.53]). In the 51 patients included in the second part of the study, significant reductions in body weight and visceral fat areas occurred after surgery, regardless of whether the patients were previously obese. Triglycerides, LDL-cholesterol, and plasminogen activator inhibitor-1 levels were significantly decreased, whereas HDL-cholesterol and adiponectin levels were increased. Carotid intima-media thickness also was significantly decreased in previously obese and nonobese patients.


CONCLUSIONS
Patients with EGC who undergo gastrectomy have a lower cardiovascular mortality but similar all-cause mortality as that of the general population. In these patients, a significant reduction in body weight and visceral fat after surgery may improve impaired lipid metabolism and prevent atherosclerotic changes.
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
Yong-Ho
YH
Lee
Seung Jin
SJ
Han
Hyeon Chang
HC
Kim
Woo Jin
WJ
Hyung
Joon Seok
JS
Lim
Kwangsuk
K
Lee
Hyun Joo
HJ
Lee
Eun Young
EY
Lee
Eun Seok
ES
Kang
Chul Woo
CW
Ahn
Bong Soo
BS
Cha
Hyun Chul
HC
Lee
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000209:etiology / Q000401:mortality*; D059168:Carotid Intima-Media Thickness / Q000401:mortality*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000401:mortality*; D006801:Humans; D050356:Lipid Metabolism; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications; D011379:Prognosis; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000150:complications / Q000401:mortality* / Q000601:surgery; D015996:Survival Rate; D055815:Young Adult