Assessment of the risk of cardiovascular complications in cancer surgery

Abstract

Cardiac complications of non-cardiac surgeries are an actual and unresolved interdisciplinary problem of clinical medicine today. The incidence of cardiovascular events after non-cardiac surgery is higher than in the general population and does not tend to decrease. The risk of cardiac complications in cancer surgery is the highest. Evidence-based approaches to risk assessment and prevention of cardiovascular events in surgical patients with malignant neoplasms have not been developed. In current clinical guidelines on the prevention, prognosis and treatment of cardiac complications of non-cardiac surgeries, the aspects of this problem in surgical oncology are not considered separately.The aim of this review was to analyze the current sources of literature on the prediction of cardiovascular complications in surgical treatment of cancer patients. The distinctive features of cancer surgery and additional factors causing an increased risk of adverse cardiac outcomes in patients with malignant neoplasms are described. The article presents the results of large cohort studies on the search for reliable predictors of cardiac complications in non-cardiac surgery and on the development of stratification scales and algorithms for preoperative risk assessment. Particular attention is paid to the possibilities and prospects of using these predictive tools in the surgical treatment of cancer. The surgical risks of interventions for malignant neoplasms are described, as well as methods for calculating cardiac risk and functional status assessment that have been validated in oncological patients cohorts. The data of recent studies on the role of serum biomarkers of myocardial damage and increased cardiovascular risk (cardiac troponins and brain natriuretic peptide) in predicting postoperative cardiac events in non-cardiac surgery are presented. Further prospects for the inclusion of biomarkers in risk stratification systems in patients with malignant neoplasms are discussed.

Assessment and correction of the risk of cardiac complications during non-cardiac surgery

“…-рекомендации по оценке и коррекции сердечно-сосудистых рисков при некардиальных операциях [5]. Тем не менее, число статей по данной проблеме не снижается, в том числе, и в отечественных журналах [6][7][8][9], и этому есть вполне объективные причины. Во-первых, проведение многоцентровых рандомизированных клинических исследований по данной теме крайне затруднено, из-за того, что вопросы периоперационного ведения больных обсуждаются мультидисциплинарной командой, которая руководствуется зачастую локальным опытом и установками.…”