Surgery for gastric cancer in patients with coronary heart disease (clinical cases)

The importance of a multidisciplinary approach in the surgical treatment of patients with severe combined oncological and cardiovascular pathologies is shown. In modern surgery, there is a place for both simultaneous and staged surgical treatment of this category of patients, which should be determined in each specific clinical case and requires an individual multidisciplinary approach with the inclusion in the discussion of such specialists as an oncosurgeon, a chemotherapist, a radiation therapist, a cardiologist/therapist, cardiovascular surgeon, anesthesiologist and resuscitator. Two clinical cases of a two-stage and one-stage surgical approach in the treatment of patients with competing gastric cancer and coronary heart disease are presented. One 47-year-old patient underwent two-stage surgical treatment: stage 1 aortocoronary bypass grafting from mini-thoracotomy (MICS CABG); stage 2 robot-assisted distal subtotal resection of the stomach (Balfour modification) with D2 lymphadenectomy, formation of intracorporeal gastroenteroanastomosis and interintestinal anastomosis according to Brown. Another 74-year-old patient underwent a one-stage surgical intervention: autovenous coronary artery bypass grafting of the anterior interventricular artery, posterior descending coronary artery on a beating heart, without cardiopulmonary bypass + extended-combined gastrectomy with resection of the distal esophagus, resection of the diaphragm, and D2+ lymphadenectomy. The postoperative period proceeded without complications.