Patient case: 52-year-old male with Colon cancer. Genetic variant: KRAS (G13D), BRAF (V600E). Other conditions: Type II Diabetes, Hypertension.

Clinical trial: Patients Undergoing Major Cancer Surgery: Incidence and Predictive Value for Postoperative Cardiac Events

Summary: The purpose of this study is to look at a new method for finding out if patients have a risk of heart complications from surgery. At the present, to find out if patients have a risk of heart complications from surgery, look at whether the patient has heart disease, diabetes, kidney problems, and stroke. The investigators hope that this study will confirm a new, safe test to help us predict the risk of surgery.


Eligibility: Inclusion Criteria:
  -  Age 50 or older
  -  Undergoing High Risk Cancer Surgery (Patient must be undergoing one of the following procedures NOTE: All open or robotic forms of the following procedures meet the eligibility criteria. GMT/ Hepatobiliary
  -  Pancreatic Resection
  -  Retroperitoneal Sarcomas
  -  Shoulder (Forequarter) Amputation
  -  Esophagectomy, Esophagogastrectomy
  -  Pheochromocytoma
  -  Liver Resection (with or without Bile Duct Resection) Orthopedics
  -  Spine Resections (with or without Spinal Fusion)
  -  Metastatic Disease Requiring Total Hip Replacement
  -  Total Shoulder Replacement / Forequarter Amputation
  -  Hemipelvectomy
  -  Sacrectomy Thoracic
  -  Extrapleural Pneumonectomy
  -  Pleurectomy and Decortication
  -  Pneumonectomy
  -  Esophagogastrectomy
  -  Mediastinal Tumor Resection
  -  Pancoast Tumor
  -  Completion Pneumonectomy
  -  Lobectomy (post-induction chemotherapy; or severe COPD)
  -  Segmentectomy Colorectal/ GYN
  -  Colon Resection with possible Sacrectomy
  -  Pelvic Exenteration
  -  Advanced ovarian cancer resection with or without liver resection Urology
  -  Radical Cystectomy
  -  Open Radical Prostatectomy
  -  Nephrectomy with Vena Caval Resection Head & Neck
  -  Thyroid Resection with Mediastinal involvement
  -  Major head and neck cancer resection with Free Flap reconstruction Other
  -  Unclassified Major Surgery at the Discretion of the PI
  -  Postoperative stay likely to be 2 or more days
  -  Patients willing to tolerate inflation of a blood pressure cuff for 5 minutes
  -  Patients willing to cut long nails in order to wear finger probe.
  -  Patients with one or more of the following RCRI risk factors:
  -  History of ischemic heart disease (any)
  -  History of myocardial infarction
  -  History of positive exercise test
  -  Current complaint of chest pain considered secondary to myocardial ischemia
  -  Use of nitrate therapy
  -  ECG with pathological Q waves
  -  History of congestive heart failure (any)
  -  History of congestive heart failure
  -  Pulmonary edema
  -  Paroxysmal nocturnal dyspnea
  -  Bilateral rales or S3 gallop
  -  Chest radiograph showing pulmonary vascular redistribution
  -  History of cerebrovascular disease (any)
  -  History of transient ischemic attack (TIA) or stroke
  -  Preoperative treatment with insulin
  -  Preoperative serum creatinine > 2.0 mg/dL
  -  Evidence of peripheral vascular disease other than cerebral vascular disease (Although peripheral vascular disease is not strictly a RCRI risk factor, Fleisher indicates: "It would not be inappropriate to assume that any atherosclerotic class of disease is equivalent to ischemic heart disease for risk purposes."
  Exclusion Criteria:
  -  Medical conditions precluding use of arm blood pressure measurements such as prior lymphadenectomy, vascular shunts for dialysis or upper extremity occlusive vascular disease
  -  Patients undergoing emergency surgery
  -  Any of the following active conditions
  -  Unstable coronary syndromes
  -  Uncompensated heart failure; worsening or new onset CHF
  -  Significant arrhythmias
  -  Atrial fibrillation, presently
  -  High grade AV block
  -  Symptomatic ventricular arrhythmias or new ventricular arrhythmias
  -  Supraventricular arrhythmias with poor rate control
  -  Symptomatic bradycardia
  -  Severe valvular disease
  -  Severe aortic stenosis (mean transvalvular gradient >40mmHg)
  -  Symptomatic mitral stenosis
  -  Any other condition that at the judgment of the investigator might require additional evaluation and treatment before surgery.

Relevance to patient case: not relevant