High morbidity in myocardial infarction and heart failure patients after gastric cancer surgery

Table 1 Characteristics of patients with underlying heart disease n (%)

Factors	Value
Age (yr)	68.8 ± 8.1
Sex
Male	171 (77.4)
Female	50 (22.6)
Tumor location
Upper	30 (13.6 )
Middle	65 (29.4)
Lower	123 (55.7)
Entire	2 (0.9)
Tumor size	3.9 ± 0.04
TNM stage1
I	130 (58.8)
II	37 (16.7)
III	53 (24)
IV	1 (0.5)
Op time (min)	215 ± 86
Hospital stay	13.6 ± 13.5
Approach methods
Open	177 (80.1)
Laparoscopy assisted	44 (19.9)
Combined organ resection
No	180 (81.4)
Yes	39 (17.6)
Operation type
Subtotal gastrectomy	177 (80.1)
Total gastrectomy	44 (19.9)
LN dissection2
D1	12 (5.4)
D1+	47 (21.3)
D2	162 (73.3)
Reoperation	6 (2.7)
Morbidity rate	52 (23.5)
Mortality rate	6 (2.7)

¹AJCC TNM stage 7^th edition;

²Japanese gastric cancer treatment guidelines 2010 (ver.3). LN: Lymph node.

Table 2 Associated heart disease in 4 different heart disease groups n (%)

Associated heart disease	Angina	AF	HF	MI
Aortic aneurysm	1 (1.1)
3 vessels disease	1 (1.1)		2 (15.4)
MR, TR, AR	5 (5.6)	24 (34.8)	2 (15.4)	16 (32)
Mitral stenosis		2 (2.9)	1 (7.7)
Aortic stenosis		1 (1.4)
LVE		1 (1.4)
LAE		2 (2.9)
LVH	1 (1.1)	2 (2.9)
DCMP			1 (7.7)
Sinus bradycardia	1 (1.1)
PVC	1 (1.1)	1 (1.4)		2 (4)
AF with RVR	2 (2.2)
AF with SVR	1 (1.1)
Complete AV block	1 (1.1)			1 (2)
LBBB	1 (1.1)
WPW syndrome	1 (1.1)
Arrhythmia				1 (2)
Dextracardia	1 (1.1)

PVC: Premature ventricular contractions; MR: Mitral regurgitation; TR: Tricuspid regurgitation; AR: Atrial regurgitation; LVH: Left ventricle hypertrophy; DCMP: Dilated cardiomyopathy; LVE: Left ventricular enlargement; LAE: Left atrial enlargement; AF with RVR: Atrial fibrillation and rapid ventricular response; AF with SVR: Atrial fibrillation and slow ventricular response; AV block: Atrioventricular block; LBBB: Left bundle branch block; WPW syndrome: Wolff-Parkinson-White syndrome.

Table 3 Univariate morbidity analysis of operative risk factors in patients with underlying heart disease n (%)

Factors	Patient	Complication	P value	OR
Age (yr)			0.11
> 70	103	19 (18.4)
≤ 70	118	33 (28)
Sex			0.85
Male	171	41 (24)
Female	50	11 (22)
OP risk by Cardiologist			0.34
low	31	5 (16.1)
moderate	103	27 (26.2)
high	21	7 (33.3)
ASA score			0.19
1	14	1 (7.1)
2	122	27 (22.1)
3	85	24 (28.2)
Preop anticoagulation Tx			1.00
No	104	24 (23.1)
Yes	117	28 (23.9)
Tumor location			0.12
Lower body	30	12 (40.0)
Middle body	65	15 (23.1)
Upper body	123	25 (20.5)
Whole stomach	2	0 (0)
Tumor size			0.62
> 4 cm	129	28 (21.7)
≤ 4 cm	87	22 (25.3)
Tumor depth1			0.11
T1 (mucosa, submucosa)	121	23 (29)
T2 (muscle)	21	5 (23.8)
T3 (subserosa)	36	8 (22.2)
T4 (serosa exposure, serosa invasion)	43	16 (37.2)
LN metastasis1			0.01
N0	141	25 (17.7)		1.0
N1 (1-2)	28	8 (28.6)		1.8
N2 (3-6)	24	6 (25)		1.5
N3 (7-)	28	13 (46.4)		4.0
TNM stage1			0.058
I	130	23 (17.7)
II	37	10 (28.927)
III	53	19 (35.8)
IV	1	0 (0)
Approach methods			0.12
Open gastrectomy	177	45 (25.4)
Laparoscopy assisted gastrectomy	44	7 (15.9)
Operation type			0.03
Subtotal gastrectomy	177	36 (20.3)		1.0
Total gastrectomy	44	16 (36.4)		1.3
Operation time			0.75
< 200	89	21 (23.6)
> 200	109	29 (26.6)
LN dissection2			0.28
D1	12	3 (25)
D1+	47	7 (14.9)
D2	162	42 (25.9)
Combined organ resection			0.53
No	180	41 (22.8)
Yes	39	11 (28.2)
Preop chemotherapy			1.00
No	220	52 (23.6)
Yes	1	0 (0)

¹AJCC TNM stage 7^th edition;

²Japanese gastric cancer treatment guidelines 2010 (ver.3). LN: Lymph node; OP risk by cardiologist: Operation risk evaluated by cardiologist; ASA: American society of anesthesiologists; Preop: Preoperative; Tx: Treatment.

Table 4 Univariate morbidity analysis of comorbidity in patients with underlying heart disease n (%)

Factors	Patients	Complication	P value	OR
Hypertension			0.20
No	116	23 (19.8)
Yes	105	29 (27.6)
Diabetes mellitus			0.46
No	166	37 (22.3)
Yes	55	15 (27.3)
Tuberculosis			0.53
No	206	50 (25.2)
Yes	15	2 (18.8)
Chronic liver disease			0.34
No	215	52 (24.2)
Yes	6	0 (0)
Pulmonary disease			0.52
No	205	48 (23.4)
Yes	16	4 (25)
Endocrine disease			1.00
No	216	51 (23.6)
Yes	5	1 (20)
Neurologic disease			0.02
No	202	43 (21.3)		1.0
Yes	19	9 (47.4)		1.4
Cancer history			0.66
No	214	50 (23.4)
Yes	7	2 (28.6)
Heart disease			< 0.01
Angina	89	14 (15.7)		1.0
Af	69	13 (18.8)		1.2
Hf	13	3 (23.1)		1.6
Mi	50	22 (44)		4.2

Angina: A history of angina pectoris; AF: A history of atrial fibrillation; HF: A history of heart failure; MI: A history of myocardial infarction.

Table 5 Multivariate morbidity analysis of operative risk factors and comorbidity in patients with underlying heart disease n (%)

Factors	Patients	Complication	95%CI	P value	OR
LN metastasis1				0.13
N0	141	25 (17.7)
N1	28	8 (28.6)
N2	24
N3	28	13 (46.4)
Operation type				0.04
Subtotal gastrectomy	177	36 (20.3)			1.0
Total gastrectomy	44	16 (36.4)	1.0-4.6		2.1
Neurologic disease				0.01
No	202	43 (21.3)			1.0
Yes	19	9 (47.4)	1.0-2.1		1.5
Heart disease				< 0.01
Angina	89	14 (15.7)			1.0
AF	69	13 (18.8)	0.4-2.4		1.0
HF	13	3 (23.1)	0.4-7.3		1.7
MI	50	22 (44.0)	1.8-9.5		4.2

¹AJCC TNM stage 7^th edition. LN: Lymph node; Angina: A history of angina pectoris; AF: A history of atrial fibrillation; HF: A history of heart failure; MI: A history of myocardial infarction.

Table 6 Differences in morbidities and mortalities in the 4 different heart diseases groups n (%)

Complication	Angina(n = 89)	AF(n = 69)	HF(n = 13)	MI(n = 50)	P value
Leakage	2 (2.2)	2 (2.9)	0	2 (4.0)	0.85
Intraabdominal abscess	1 (1.1)	2 (2.9)	0	5 (10)	0.04
Wound problem	5 (5.6)	4 (5.8)	0	2 (4.0)	0.81
Postop bleeding	3 (3.4)	1 (1.4)	0	5 (10)	0.09
Pulmonary Cx	2 (2.2)	3 (4.3)	1 (7.7)	5 (10)	0.22
Urologic Cx	2 (2.2)	0 (0)	0	2 (4.0)	0.39
Cardiac problem	2 (2.2)	3 (4.3)	3 (23.1)	3 (6.0)	0.01
Vascular Cx	0 (0)	3 (4.3)	0	1 (2.0)	0.22
Total morbidity	14 (15.7)	13 (18.8)	3 (23.1)	22 (44)	< 0.01
Mortality	2 (2.2)	2 (2.9)	1 (7.7)	1 (2.0)	0.70

Angina: A history of angina pectoris; AF: A history of atrial fibrillation; HF: A history of heart failure; MI: A history of myocardial infarction; postop: Postoperative; Cx: Complicatio.