Abstract
BackgroundThe advances in surgical techniques, resuscitation and anesthesiology support over the last years have allowed simultaneous thoracic and abdominal operations to be made for cancer and concomitant severe heart vessel disease relieving the patient from several diseases simultaneously and achieving long lasting remission or cure.Clinical caseA simultaneous nephrectomy and coronary artery bypass grafting procedure through extended sternotomy is reported. A 63-year-old man with severe coronary artery disease was found to have renal carcinoma.DiagnosisPostoperative pathological investigation of the tumor revealed the presence of renal cell carcinoma pT3a N0 M0, G2. Coronarography revealed advanced three-vessel coronary artery disease.TreatmentWe successfully performed a simultaneous curative surgery for renal carcinoma and coronary artery bypass graft surgery under cardiopulmonary bypass using a novel technique of extended sternotomy. Simultaneous surgery thus appears to be a beneficial and safe approach for the treatment of coronary artery disease and resectable renal cancer in carefully selected patients.
Highlights
The advances in surgical techniques, resuscitation and anesthesiology support over the last years have allowed for simultaneous thoracic and abdominal operations to be made for cancer and concomitant severe heart vessel disease [3,4,5,6] relieving the patient from several diseases simultaneously and achieving long lasting remission or cure
In this paper we report the case that successfully underwent concomitant curative nephrectomy for renal cancer and Coronary artery bypass graft (CABG) under Cardiopulmonary bypass (CPB) through a novel technique of extended sternotomy
A council was arranged in the presence of a cardiologist, a cardiac surgeon, an urologist and an oncologist where it was agreed that the patient would undergo a simultaneous operation of CABG under CPB and right nephrectomy
Summary
The number of patients who have both critical coronary artery disease (CAD) and surgically resectable cancer concomitantly has been raising as the proportion of elderly in the general population increases [2]. A council was arranged in the presence of a cardiologist, a cardiac surgeon, an urologist and an oncologist where it was agreed that the patient would undergo a simultaneous operation of CABG under CPB and right nephrectomy. There were two major reasons for using this technique, first this enables the cardiac surgeon to intervene quickly in case the patient’s condition begins to deteriorate under the nephrectomy, second this technique avoids turning the patient around mid-way through the operation under general anesthesia to lay him on the back for sternotomy after having finished nephrectomy through a lateral incision. Postoperative pathological investigation of the tumor revealed the presence of renal cell carcinoma pT3a N0 M0, G2.The patient was discharged on the 7th post-operative day in good condition. One year postoperatively the patient underwent abdominal ultrasound and thoracic X-ray, both tests revealed no metastases
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