Clinical Outcomes of Laparoscopy-assisted Gastrectomy for Patients With Heart Disease

Abstract

Laparoscopy-assisted gastrectomy (LG) is an established treatment for early gastric cancer. However, CO2 pneumoperitoneum during laparoscopic surgery can adversely affect cardiac function in the presence of heart disease (HD). We performed LG in 546 patients and conventional open gastrectomy (OG) in 448 patients. Patients with preoperatively diagnosed and treated HD were identified. The clinical outcomes of patients with HD who underwent LG (HD-LG) were compared with those of patients with HD who underwent OG (HD-OG), as well as those of patients with no operative risk who underwent LG (NR-LG). Variables of cardiac function were similar in the HD-LG and HD-OG groups. Postoperative cardiac complications did not differ between the groups (8.3% vs. 13.6%, P = 0.51). The HD-LG group had significantly more cardiac and abdominal complications than the NR-LG group (P = 0.0011 and 0.0070, respectively). LG was tolerated in patients with gastric cancer and mild or moderate HD, similar to OG.

Feasibility of laparoscopic gastrectomy for patients with poor physical status: a retrospective cohort study based on a nationwide registry database in Japan

“…In addition, increased CO 2 and peritoneal pressure adversely affected respiratory function by causing hypercarbia and reduced pulmonary ventilation [6]. It is controversial whether LG is useful for patients with poor physical status, although several single-institutional studies have supported the feasibility of LG in patients with pulmonary disease, heart disease, or poor physical status as compared with open gastrectomy (OG) [7][8][9].…”