Combined surgical treatment of oncological patient with concomitant acute coronary syndrome with tumor lesions of the gastric stump in a multidisciplinary clinic

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Abstract

Patients with various forms of coronary artery disease often suffer from other comorbid conditions that affect the quality of life and make it difficult to select the optimal therapy. The most acute problem of comorbidity manifests itself in the need for surgical treatment, especially extensive surgical interventions. The key to successful surgical treatment in this category of patients is the work of a multidisciplinary team of specialists deciding on the operability, stages of surgical interventions, choice of methods revascularization and features of patient management in the postoperative period. The article presents a case of successful surgical treatment of the patient with unstable angina and gastric stump cancer, demonstrating the well-coordinated work of a multidisciplinary team of specialists.

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About the authors

Badri V. Sigua

North-Western State Medical University named after I.I. Mechnikov

Email: dr.sigua@gmail.com
ORCID iD: 0000-0002-4556-4913
SPIN-code: 5571-8893

MD, Dr. Sci. (Med.), Professor

Russian Federation, Saint Petersburg

Igor N. Kochanov

North-Western State Medical University named after I.I. Mechnikov

Email: igor.kochanov@szgmu.ru
ORCID iD: 0000-0002-3499-1792
SPIN-code: 5944-6425

MD, Cand. Sci. (Med.), Assistant Professor

Russian Federation, Saint Petersburg

Svetlana A. Boldueva

North-Western State Medical University named after I.I. Mechnikov

Email: svetlana.boldueva@szgmu.ru
ORCID iD: 0000-0002-1898-084X
SPIN-code: 3716-3375
Scopus Author ID: 6506877971

MD, Dr. Sci. (Med.), Professor

Russian Federation, Saint Petersburg

Elgudzha L. Latariya

North-Western State Medical University named after I.I. Mechnikov

Email: Elgudzha.Latariya@szgmu.ru
ORCID iD: 0000-0002-9569-8485
SPIN-code: 7376-9672

MD, Cand. Sci. (Med.), Assistant Professor

Russian Federation, Saint Petersburg

Dmitrii V. Gurzhiy

North-Western State Medical University named after I.I. Mechnikov

Email: Dmitrii.Gurzhii@szgmu.ru
ORCID iD: 0000-0002-4005-0403

MD, Cand. Sci. (Med.)

Russian Federation, Saint Petersburg

Natalya A. Trostyanetskaya

North-Western State Medical University named after I.I. Mechnikov

Email: N.Trostyanetckaya@szgmu.ru

MD, Cand. Sci. (Med.)

Russian Federation, Saint Petersburg

Evgeny A. Zakharov

North-Western State Medical University named after I.I. Mechnikov

Author for correspondence.
Email: dr.zakharovea@gmail.com
ORCID iD: 0000-0002-2070-7420
SPIN-code: 2649-1050
ResearcherId: R-9279-2016
Russian Federation, Saint Petersburg

Anna V. Belyeva

North-Western State Medical University named after I.I. Mechnikov

Email: belyaeva-niio@yandex.ru
ORCID iD: 0000-0002-6299-2856
SPIN-code: 8205-6112

MD, Cand. Sci. (Med.)

Russian Federation, Saint Petersburg

Natalya S. Tretyakova

North-Western State Medical University named after I.I. Mechnikov

Email: TretyakovaNS@list.ru
ORCID iD: 0000-0003-3844-1429
SPIN-code: 5464-1240

MD, Cand. Sci. (Med.)

Russian Federation, Saint Petersburg

Alexey L. Efimov

North-Western State Medical University named after I.I. Mechnikov

Email: aespb@mail.ru
ORCID iD: 0000-0001-7586-6405
SPIN-code: 7854-1596

MD, Cand. Sci. (Med.), Assistant Professor

Russian Federation, Saint Petersburg

Maria S. Emilyanova

North-Western State Medical University named after I.I. Mechnikov

Email: mary.emelianowa17@gmail.com
ORCID iD: 0000-0003-0555-9332
Russian Federation, Saint Petersburg

Vyacheslav P. Zemlyanoy

North-Western State Medical University named after I.I. Mechnikov

Email: vyacheslav.zemlyanoy@szgmu.ru
ORCID iD: 0000-0001-7368-5926

MD, Dr. Sci. (Med.), Professor

Russian Federation, Saint Petersburg

References

  1. Davydov MI, Akchurin RS, Gerasimov SS, et al. Simultaneous surgery of competing cardio-vascular and malignant diseases of lungs and mediastinum. Pirogov Russian Journal of Surgery. 2010;8:4–10. (In Russ.)
  2. Davydov MI, Akchurin RS, Gerasimov SS, et al. Surgical treatment of patients with stomach cancer and severe concomitant cardio-vascular pathology. Pirogov Russian Journal of Surgery. 2013;9:4–13. (In Russ.)
  3. Hirose H, Amano A, Yoshida S, et al. Coronary artery bypass grafting in patients with malignant neoplasm. Efficacy of coronary artery bypass grafting on beating heart. Jpn J Thorac Cardiovasc Surg. 2000;48:(2):96–100. doi: 10.1007/bf03218098
  4. Ochi M, Yamada K, Fujii M, et al. Role of off-pump coronary artery bypass grafting in patients with malignant neoplastic disease. Jpn Circ J. 2000;64(1):13–17. doi: 10.1253/jcj.64.13
  5. Tsuji Y, Morimoto N, Tanaka H, et al. Surgery for gastric cancer combined with cardiac and aortic surgery. Arch Surg. 2005;140(11):1109–1114. doi: 10.1001/archsurg.140.11.1109
  6. Civelec A, Ak K, Isbir CS, et al. Simultaneous gastrectomy and off-pump coronary artery bypass grafting: a case report. Turkish J Thoracic Cardiovasc Surg. 2011;19(4):642–644. doi: 10.5606/tgkdc.dergisi.2011.104
  7. Bezdenezhnykh AV, Sumin AN, Oleinik PA, et al. Simultaneous operative intervention — coronary shunting on the working heart and gastrectomy in cancer of the antral part of the stomach. Siberian Medical Review. 2017;(3(105)):108–111. (In Russ.). doi: 10.20333/2500136-2017-3-108-111

Supplementary files

Supplementary Files
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1. JATS XML
2. Fig. 1. Endoscopy. Exophytic tumor of the gastric stump with decay

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3. Fig. 2. Diagnostic coronary angiography. Subocclusion is visualized in the middle third of the left anterior descending artery

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4. Fig. 3. Control angiography after stent placement in the left anterior descending artery subocclusion zone

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5. Fig. 4. Gross specimen

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6. Fig. 5. X-ray of the esophagojejunoanastomosis zone. The anastomosis is passable, no contrast agent leaks have been detected

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