Abstract

Patients with advanced cancer commonly undergo major surgical procedures, which, despite offering potential benefits in survival and quality of life, pose a heightened risk of arterial ischemic events such as ischemic stroke (IS) and myocardial infarction (MI). Malignancy-related hypercoagulability, surgical stress, and existing cardiovascular comorbidities may converge to amplify this risk. In this single-center retrospective cohort study, 233 patients with advanced cancer (breast, colorectal, upper gastrointestinal, lung, gynecological, pancreatic, or urological tumors) who underwent major surgery between 2021 and 2023 were analyzed. Using hospital records, we identified IS and MI events within one year of surgery. We employed logistic regression to estimate odds ratios (ORs) for events during hospitalization and used flexible parametric survival models to calculate hazard ratios (HRs) post-discharge. Sensitivity analyses excluded less invasive procedures, and relevant comorbidities were included as predefined risk factors. The median age of the cohort was 66 years, and 51.9% were male. The one-year cumulative incidence was 1.3% for both IS and MI. Pancreatic and lung cancers exhibited notably higher risk profiles, with ORs for MI and IS of 8.71 and 7.39 in pancreatic cancer, and 9.25 and 8.62 in lung cancer, respectively. Men had slightly higher event rates than women, and patients under 50 years demonstrated comparatively lower risks. Most events clustered in the early postoperative period. IS and MI pose a considerable risk in patients with advanced cancer undergoing major surgery, particularly in pancreatic and lung cancers. Focused perioperative management, including vigilant monitoring and targeted antithrombotic interventions, may mitigate the burden of these complications, ultimately improving postoperative outcomes in this vulnerable population.

Key words: Advanced cancer, postoperative stroke, myocardial infarction, arterial ischemic events, risk factors, perioperative management