Key result
Preoperative LVEF <50% is linked to ~3.2-fold higher mortality after gastrectomy in older adults.
Why the study?
The prognostic effect of left ventricular systolic dysfunction in older adult patients with gastric cancer has not been fully elucidated.
Does preoperative left ventricular systolic dysfunction worsen mortality and postoperative complications in older adult patients with gastric cancer undergoing curative gastrectomy?
Cohort (n=237)
No
Does preoperative left ventricular systolic dysfunction worsen mortality and postoperative complications in older adult patients with gastric cancer undergoing curative gastrectomy?
Preoperative left ventricular systolic dysfunction (LVEF <50%) is an independent predictor of worse long-term overall survival and increases the risk of postoperative pneumonia in older adult patients undergoing curative gastrectomy.
May support preoperative LVEF screening for risk counseling in elderly gastrectomy patients; extends noncardiac surgery data but leaves open prospective validation.
BACKGROUND/AIM: The effect of left ventricular systolic dysfunction (LVSD), a risk factor for postoperative mortality, in older adult patients with gastric cancer has not been fully elucidated. This study aimed to evaluate the impact of low preoperative left ventricular ejection fraction (EF) on short- and long-term outcomes in older adult patients with gastric cancer. PATIENTS AND METHODS: This retrospective study enrolled 237 older adult patients with gastric cancer (≥75 years old) who underwent preoperative echocardiography and curative gastrectomy. LVSD was defined as an EF <50%. Postoperative complications and prognosis were compared between patients with low- and normal-EF using the Fisher's exact or Chi-square test, log-rank test, Kaplan-Meier method, and Cox regression analysis. RESULTS: Thirteen patients (5.4%) exhibited LVSD. The incidence of postoperative complications was not significantly different between the two groups (p=0.470), although the incidence of pneumonia was high (p=0.003) and overall survival was significantly worse in the low-EF group compared to the normal-EF group (p=0.016). Multivariate analysis revealed that decreased EF, low preoperative body mass index, and advanced pathological stage were significant prognostic factors in older adult patients with gastric cancer. CONCLUSION: LVSD increases the risk of postoperative pneumonia and has a negative prognostic impact on older adult patients with gastric cancer.
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Takabatake et al. (2024) conducted a cohort in Gastric Cancer (n=237). Preoperative left ventricular systolic dysfunction (LVEF <50%) vs. Normal left ventricular ejection fraction (≥50%) was evaluated on Overall survival (HR 3.23, p=0.025). Preoperative left ventricular systolic dysfunction (LVEF <50%) independently worsened overall survival (HR 3.23, p=0.025) and increased postoperative pneumonia risk in older adults after gastrectomy.
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