Objectives: We investigated cardiovascular and all-cause mortality in patients who underwent gastrectomies for early gastric cancer (EGC), and analyzed the changes in metabolic parameters in these patients after surgery.
Background: Bariatric surgery, including gastric banding and gastric bypass, effectively induces weight loss and resolves cardiovascular comorbidities in obese patients.
Methods: 2477 patients who underwent gastrectomies for EGC between 1995 and 2004 were enrolled and followed for mortality through 2007. Standardized mortality ratios (SMRs) were calculated using sex- and age-matched mortality in the general Korean population in 2005. Effects of gastrectomy on changes in metabolic profiles including carotid intima-media thickness (CIMT) were investigated.
Results: During the 15 096.4 person-years of follow-up in 2477 patients, 244 deaths were recorded. The all-cause mortality was not significantly different from that of the general population (SMR (95% CI)=1.01 (0.891.14)); however, cardiovascular mortality was significantly lower (SMR=0.35 (0.220.53)). In the 51 patients included in the second part of the study, significant reductions in body weight and visceral fat areas occurred after surgery, regardless of whether the patients were previously obese. Triglycerides, LDL-cholesterol, and plasminogen activator inhibitor-1 levels were significantly decreased, whereas HDL-cholesterol and adiponectin levels were increased. CIMT was also significantly decreased in previously obese and non-obese patients.
Conclusions: Patients with EGC who undergo gastrectomy have a lower cardiovascular mortality but similar all-cause mortality as that of the general population. In these patients, a significant reduction in body weight and visceral fat after surgery may improve impaired fibrinolytic homeostasis and lipid metabolism and prevent atherosclerotic changes.
Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.
Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.