Consult: 77-year-old man for consideration of laparoscopic partial gastrectomy
- Recent hospital admission with Haemoglobin of 48, inpatient blood transfusion and iron infusion
- Imaging revealed distal gastric tumour, no metastatic disease.
- Severe COPD
- AF – NOAC
- Peripheral Vascular Disease – previous bilateral LL stents
- CKD – Stage 1
- Spirometry in clinic and subsequent formal PFTs showed FEV1 = 0.91 (39%), PEFR = 23%, FEF25-75%=16% predicted.
- Recent Exacerbation COPD requiring steroid therapy
- Troponin rise to 50 during last admission, associated with anaemia
- Echocardiogram unremarkable
- DASI 3.9 MET’s
- CFS = 5. Scores greater than 3 indicate increasing risk of adverse perioperative outcomes. See Rockwood article on clinical frailty DOI:10.1503/cmaj.050051
- Respiratory function very concerning, has stopped smoking and has regular reviews with respiratory physician. On optimal therapy.
- Increased risk of postoperative pulmonary complications:
- GUPTA Postoperative respiratory failure risk =13% and postoperative pneumonia risk= 19%.
- ARISCAT score: 45 = High Risk of post-operative pulmonary complications.
- Aggressive pathology – opportunities for optimisation are time-limited
- Consensus that an open procedure would not be advisable in this patient. Surgical team in agreement with this assessment but should revisit this discussion preoperatively
- Further discussion with surgical team regarding meeting outcomes
- Proceed with laparoscopic gastrectomy
- ICU 2 postoperative bed