TWO CASES OF ADVANCED BLEEDING CANCER OF THE GASTROINTESTINAL TRACT WITH ISCHEMIC CARDIAC DISEASE

Abstract

Patient 1 was a 65-year-old woman who had a bleeding advanced cancer of the sigmoid colon and 2 vessel coronary artery disease which had been treated by percutaneous transluminal coronary angioplasty (PTCA) unsuccessfully. She underwent a sigmoidectomy following a coronary artery bypass gafting (CABG) under the beating heart without cardiopulmonary bypass (off pump CABG=OPCAB) simultaneously. Composite graft using the in-situ right intrnal thoracic artery (ITA) and the inferior epigastric artery was bypassed to the right cornary artery (RCA) and left ITA to the left descending coronary artery (LAD). Patient 2 was a 79-year-old man with bleeding advanced gastric cancer and 3 vessel coronary artery disease. He had a total gastrectomy after OPCAB (aorta to the RCA and LAD using the saphenous vein). Both patients were discharged with patent grafts. For the patients with advanced cancer and severe coronary disease, simultaneous treatment seems to be appropriate, making allowances for probable aggravation of the cancer and avoidance of perioperative cardiac events. We think OPCAB is a useful option to minimize bleeding, cardiac events and surgical stress.