215 The Role of Cardiopulmonary Exercise Testing in Patients Undergoing Gastrectomy at a Scottish High-Volume Unit

Abstract Aim Cardiopulmonary exercise testing (CPET) is established in the risk stratification of patients undergoing oesophagectomy but there is limited data for its utility in patients undergoing gastrectomy. This study examines the relationship between CPET and patient outcomes following gastrectomy. Method Consecutive subtotal/total gastrectomy outcomes from a single Scottish high-volume unit from 2010-24 were retrospectively analysed from a prospectively maintained database. Selected high-risk patients as identified by surgeon/anaesthetist underwent further preoperative workup including CPET, performed at the time of diagnosis prior to any neoadjuvant chemotherapy. Descriptive statistics, Wald testing, and multivariate analysis were used with primary outcome measures defined as in-hospital mortality, unplanned intensive care (ITU) admission, and all cause Clavien Dindo ≥III (CD3+). Results 404 patients underwent subtotal (213) or total gastrectomy (191). Median age was 68 years, 63.38% male, and 59.62% underwent neoadjuvant chemotherapy. CPET was undertaken in 213 patients (52.72%), with median AT 11.4 (57.75% AT >11). In-hospital mortality in the entire cohort was 2.48% (n=10). In patients assessed by CPET, in-hospital mortality was 2.35% (n=5) and unplanned ITU admission 7.04% (n=15). Statistically significant outcomes associated with lower AT included peri-operative blood transfusion (p=0.03), in-hospital mortality (p=0.02), CD3+ complications (p=0.03), and LOS (p=0.03). AT <9 correlates with unplanned ITU admission (p=0.03), reintubation (p<0.01), and in-hospital mortality (p=0.01). Conclusions Gastrectomy remains a significant operative insult with a sizeable risk profile. Though with lower cutoff than patients undergoing oesophagectomy, low AT predicts medium-term outcome and can further inform preoperative counselling in patients under consideration for gastrectomy.