Retrospective Study
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World J Gastrointest Surg. Aug 27, 2014; 6(8): 146-150
Published online Aug 27, 2014. doi: 10.4240/wjgs.v6.i8.146
Simultaneous operation for cardiac disease and gastrointestinal malignancy
Teruo Komokata, Mikio Fukueda, Mamoru Kaieda, Takayuki Ueno, Yoshihumi Iguro, Yutaka Imoto, Ryuzo Sakata
Teruo Komokata, Mamoru Kaieda, Takayuki Ueno, Department of Surgery, Kagoshima Medical Center, National Hospital Organization, Kagoshima 892-0853, Japan
Mikio Fukueda, Yoshihumi Iguro, Yutaka Imoto, Cardiovascular and Gastroenterological Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima 890-8520, Japan
Ryuzo Sakata, Cardiovascular Surgery, Kyoto University Hospital, Kyoto 606-8397, Japan
Author contributions: Komokata T designed the study and provided the collection of the clinical data; Komokata T and Fukueda M wrote the manuscript; Kaieda M, Ueno T, Iguro Y, and Sakata R participated in the simultaneous surgery; Imoto Y and Sakata R were involved in editing the manuscript.
Correspondence to: Teruo Komokata, MD, PhD, Department of Surgery, Kagoshima Medical Center, National Hospital Organization, 8-1 Shiroyama, Kagoshima 892-0853, Japan. komokata@kagomc2.hosp.go.jp
Telephone: +81-99-2231151 Fax: +81-99-2269246
Received: March 6, 2014
Revised: June 20, 2014
Accepted: July 12, 2014
Published online: August 27, 2014
Abstract

AIM: To investigate the safety of performing simultaneous cardiac surgery and a resection of a gastrointestinal malignancy.

METHODS: Among 3664 elective cardiac operations performed in adults at Kagoshima University Hospital from January 1991 to October 2009, this study reviewed the clinical records of the patients who underwent concomitant cardiac surgery and a gastrointestinal resection. Such simultaneous surgeries were performed in 15 patients between January 1991 and October 2009. The cardiac diseases included 8 cases of coronary artery disease and 7 cases with valvular heart disease. Gastrointestinal malignancies included 11 gastric and 4 colon cancers. Immediate postoperative and long-term outcomes were evaluated.

RESULTS: Postoperative complications occurred in 5 patients (33.3%), including strokes (n = 1), respiratory failure requiring re-intubation (n = 1), hemorrhage (n = 2), hyperbilirubinemia (n = 1) and aspiration pneumonia (n = 1). There was 1 hospital death caused by the development of adult respiratory distress syndrome after postoperative surgical bleeding followed aortic valve replacement plus gastrectomy. There was no cardiovascular event in the patients during the follow-up period. The cumulative survival rate for all patients was 69.2% at 5 years.

CONCLUSION: Simultaneous procedures are acceptable for the patients who require surgery for both cardiac diseases and gastrointestinal malignancy. In particular, the combination of a standard cardiac operation, such as coronary artery bypass grafting or an isolated valve replacement and simple gastrointestinal resection, such as gastrectomy or colectomy can therefore be safely performed.

Keywords: Simultaneous operation, Cardiac disease, Gastrointestinal malignancy, Gastric cancer, Colon cancer

Core tip: Simultaneous surgical interventions for cardiovascular and gastrointestinal pathology have not been well adapted so far. Staged procedure, depending on the clinical priority is usually preferred. Concomitant cardiac and gastrointestinal surgery holds a bundle of advantages with some challenges. We reviewed the outcome in 15 patients who underwent simultaneous cardiovascular and gastrointestinal surgery at Kagoshima University Hospital. Postoperative complications were noted in 5 cases, with 1 death. No adverse cardiovascular events were noted during follow up. The cumulative survival rate for all patients was 69.2% at 5 years. Synchronized cardiovascular and gastrointestinal procedures can be safely performed when needed.