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- Title
An adequate perioperative management and strategy for gastric cancer after coronary artery bypass using the right gastroepiploic artery.
- Authors
Mita, Kazuhito; Ito, Hideto; Fukumoto, Masato; Murabayashi, Ryo; Koizumi, Kazuya; Hayashi, Takashi
- Abstract
Purpose: Interruption of the right gastroepiploic artery (RGEA) used for prior coronary artery bypass grafting (CABG) may cause life-threatening myocardial ischemia during gastrectomy. This study investigated the cases treated in this department and pooled data in the literature to identify an adequate perioperative RGEA management strategy. Methods: Eight patients underwent gastrectomy after CABG with the RGEA. This study examined conditions, management of the RGEA, No. 6 lymph node metastasis, and complications of these cases and those in the pooled data. Results: Percutaneous coronary intervention or a redo CABG was performed in advance in 7 and 1 patients, respectively. The RGEA was resected for dissection of No. 6 lymph nodes in 6 patients. Five patients had lymph node metastasis. Thirty-seven patients from 40 combined cases (92.5 %) underwent total or distal gastrectomy, but 17 patients (42.5 %) had RGEA resection. Resections of the RGEA and No. 6 lymph node metastasis were significantly higher in patients with perioperative coronary management than in those without such management. Conclusion: Coronary and celiac angiography and coronary revascularization are prerequisites to prevent cardiac events during gastrectomy and dissection of No. 6 lymph nodes should be performed with resection of RGEA. Standard lymph node dissection should therefore be performed with a curative intent for all patients even those undergoing gastrectomy after CABG using RGEA.
- Subjects
STOMACH cancer; PERIOPERATIVE care; CORONARY artery bypass; GASTROEPIPLOIC artery; MYOCARDIAL revascularization; REVASCULARIZATION (Surgery)
- Publication
Surgery Today, 2013, Vol 43, Issue 3, p284
- ISSN
0941-1291
- Publication type
Article
- DOI
10.1007/s00595-012-0224-7