Abstract: Objective To investigate the correlation between perioperative heart rate variability(HRV), inflammatory markers, and recovery patterns in patients with gastric cancer. Methods The present retrospective study involved 85 patients who underwent laparoscopic radical gastrectomy and were hospitalized at Affiliated Hospital of Nanjing University of Chinese Medicine from March 2022 to December 2024. Patients included 58 males and 27 females with the age of(64.7±10.3)years. HRV indices(SDNN, SDANN Index, PNN50, LF, HF)and serum inflammatory markers(hs-CRP, WBC, IL-2, IL-6, IL-1β, TNF-α, IFN-γ)were assessed before surgery, and on postoperative days 1 and 3. The study examined the correlations between HRV and inflammatory markers, as well as between HRV/inflammatory markers on postoperative day 1 and postoperative recovery indicators. A receiver operating characteristic(ROC)curve was generated using core diagnostic performance analysis to assess the predictive value of HRV for postoperative flatus within 48 hours following gastric cancer surgery. Results On preoperative day 1, SDNN exhibited a negative correlation with hs-CRP(r=-0.25), the SDANN Index correlated negatively with WBC(r=-0.25), and LF was negatively correlated with IL-1β(r=-0.28)and TNF-α(r=-0.26)(all P<0.05). On postoperative day 1, negative correlations were identified as follows: SDNN with hs-CRP(r=-0.46), WBC(r=-0.33), IL-2(r=-0.25), and IL-6(r=-0.40); PNN50 with hs-CRP(r=-0.40), WBC(r=-0.36), and IL-6(r=-0.33); LF with hs-CRP(r=-0.32), WBC(r=-0.21), IL-2(r=-0.53), and IL-6(r=-0.39); and HF with hs-CRP(r=-0.50), IL-2(r=-0.40), and IL-6(r=-0.60)(all P<0.05). On postoperative day 3, the following negative correlations were observed: SDNN with hs-CRP(r=-0.35), WBC(r=-0.29), IL-2(r=-0.24), and IL-6(r=-0.27); PNN50 with WBC(r=-0.49), IL-2(r=-0.25), IL-6(r=-0.28), and TNF-α(r=-0.23); LF with hs-CRP(r=-0.39), WBC(r=-0.28), and IL-2(r=-0.45); and HF with hs-CRP(r=-0.42), WBC(r=-0.39), IL-2(r=-0.44), and IL-6(r=-0.27)(all P<0.05). Additionally, postoperative initial flatus time(r=0.47)and bowel sound recovery time(r=0.36)were positively correlated with WBC. The Visual Analog Scale(VAS)score on postoperative day 1 showed a negative correlation with hs-CRP(r=-0.22)and IFN-γ(r=-0.23). Furthermore, postoperative flatus time(r=-0.22), ambulation time(r=-0.23), and bowel sound recovery time(r=-0.30)were negatively correlated with SDNN(all P<0.05). LF significantly predicted postoperative flatus within 48 hours(AUC=0.671 5, P=0.009 3). Conclusion Patients with gastric cancer show significant inverse correlations between perioperative HRV and inflammatory markers. HRV is expected to be a novel, non-invasive digital biomarker for perioperative stress states, thereby enabling prediction of postoperative recovery patterns in patients.

Key words: Heart rate variability, Autonomic nervous function, Inflammatory markers, Surgical stress, Recovery prediction