Surgical treatment of gastric and gastroesophageal junction cancer in patients with concomitant cardiovascular diseases

   Introduction: The treatment strategy for gastric cancer (GC) in patients with concomitant cardiovascular disease (CVD) remains a subject for debate due to the prevalence of CVD and the lack of clinical guidelines for surgical management of these patients.

   Aim: To review the outcomes of simultaneous and consequent surgical treatment of GC and Siewert type I–III gastroesophageal junction cancer (GJC) in patients with concomitant CVD.

   Materials and methods: Patients with resectable biopsy-proven GC and Siewert type I–III GJC were recruited between January 2020 and March 2024. Primary endpoints: numbers of deaths, intra- and postoperative complications, removed lymph nodes, and R1 resection margins rate. Secondary endpoints: duration of surgery, length of hospital stay, morbidity, and duration of the interval (days) between the stages of consequent procedures. The main group consisted of 31 GC patients with concomitant CVD (15 and 16 patients underwent simultaneous and staged procedures, respectively). The control group consisted of 69 GC patients without concomitant CVD. The groups were balanced in terms of sex, age, cancer stage, ECOG score, and type of surgical procedure. Patients in the main group had significantly higher ASA scores, and minimally invasive procedures were more common in the control group. There were no differences between the groups of simultaneous and staged surgery in any parameter.

   Results: There were no significant differences in the rate of intraoperative and postoperative complications and mortality between the groups. The duration of surgery and number of postoperative bed-days were significantly greater in the main group, and in the consequent surgery group than in the simultaneous surgery group. There were no significant differences in the rate of R1 resection margins or number of the lymph nodes removed between
the groups.

   Conclusions: No significant increase in intra- and postoperative complications were observed in patients with GC or GJC and concomitant CVD undergoing simultaneous or consequent procedures. The proportion of radically treated patients was not lower among those who had prior surgery for the concomitant disease. Neither the simultaneous nor the staged approach was more advantageous.

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