Preoperative Cardiac Risk Assessment and Surgical Outcomes of Patients with Gastric Cancer.
OBJECTIVE
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.
Department of Surgery, Nara Medical University School of Medicine, Kashihara, Nara, Japan. msohei@naramed-u.ac.jp.
Sohei
S
Matsumoto
Department of Surgery, Nara Medical University School of Medicine, Kashihara, Nara, Japan.
Tomoyoshi
T
Takayama
Department of Surgery, Nara Medical University School of Medicine, Kashihara, Nara, Japan.
Kohei
K
Wakatsuki
Department of Surgery, Nara Medical University School of Medicine, Kashihara, Nara, Japan.
Tetsuya
T
Tanaka
Department of Surgery, Nara Medical University School of Medicine, Kashihara, Nara, Japan.
Kazuhiro
K
Migita
Department of Surgery, Nara Medical University School of Medicine, Kashihara, Nara, Japan.
Masahiro
M
Ito
Department of Surgery, Nara Medical University School of Medicine, Kashihara, Nara, Japan.
Hiroshi
H
Nakade
Department of Surgery, Nara Medical University School of Medicine, Kashihara, Nara, Japan.
Tomohiro
T
Kunishige
Department of Surgery, Nara Medical University School of Medicine, Kashihara, Nara, Japan.
Yoshiyuki
Y
Nakajima
D000230:Adenocarcinoma / Q000556:secondary / Q000601:surgery*; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000009:adverse effects*; D006333:Heart Failure / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D008197:Lymph Node Excision / Q000009:adverse effects; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011183:Postoperative Complications; D011300:Preoperative Care; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate