Frail, polymorbid patient for gastrectomy

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
  • Asbestosis
  • 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
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  • 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