Clinical outcomes of laparoscopy-assisted gastrectomy for patients with heart disease

Area of Science:

• Gastroenterology
• Cardiology
• Surgical Oncology

Background:

• Laparoscopy-assisted gastrectomy (LG) is a standard treatment for early gastric cancer.
• Carbon dioxide (CO2) pneumoperitoneum during LG can negatively impact cardiac function, especially in patients with pre-existing heart disease (HD).

Purpose of the Study:

• To compare the clinical outcomes of patients with HD undergoing LG versus conventional open gastrectomy (OG).
• To evaluate the safety and tolerability of LG in patients with HD.

Main Methods:

• Retrospective analysis of 546 patients who underwent LG and 448 who underwent OG.
• Identification and comparison of patients with preoperatively diagnosed and treated HD in both LG (HD-LG) and OG (HD-OG) groups.
• Comparison of HD-LG group outcomes with a no-operative-risk LG (NR-LG) group.

Main Results:

• Cardiac function variables were comparable between the HD-LG and HD-OG groups.
• Postoperative cardiac complication rates did not significantly differ between HD-LG and HD-OG groups (8.3% vs. 13.6%, P=0.51).
• The HD-LG group exhibited significantly higher cardiac and abdominal complication rates compared to the NR-LG group (P=0.0011 and P=0.0070, respectively).

Conclusions:

• Laparoscopy-assisted gastrectomy is well-tolerated in patients with gastric cancer and mild or moderate heart disease, demonstrating similar cardiac outcomes to open gastrectomy.
• Patients with heart disease undergoing LG should be closely monitored due to a higher risk of overall complications compared to those without heart disease.