Postoperative Complications and Long-Term Cardiovascular Risk After Gastrectomy for Gastric Cancer

As survival after gastrectomy for gastric cancer improves, long-term noncancer outcomes such as cardiovascular disease (CVD) have become increasingly important. Whether postoperative complications are associated with long-term CVD risk remains unclear.

We conducted a nationwide, population-based cohort study using the Korea National Health Insurance Service database. Adults aged ≥ 20 years without prior CVD who underwent gastrectomy for newly diagnosed gastric cancer between 2006 and 2019 were included. Postoperative complications within 30 days were identified using ICD-10 codes and classified as pulmonary, surgical wound, gastrointestinal, urinary, or bleeding complications. The primary outcome was incident CVD, defined as myocardial infarction, stroke, heart failure, or cardiovascular death. Adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated using multivariable Cox proportional hazards models.

Among 3850 patients (median follow-up 5.3 years), 823 (21.4%) experienced postoperative complications and 162 developed CVD. The incidence rate of CVD was 12.1 and 7.0 per 1,000 person-years in patients with and without complications, respectively (absolute difference, 5.1 per 1000 person-years). Postoperative complications were associated with a higher risk of CVD (HR 1.63; 95% CI 1.15-2.30), even after adjustment for sociodemographic, clinical, and cancer-related factors. Pulmonary complications showed the strongest association, and the association was particularly evident for heart failure.

Postoperative complications after gastrectomy are associated with an increased long-term risk of CVD. These findings support closer cardiovascular surveillance and risk management in patients who experience postoperative complications.