How do we manage the gastrectomy for gastric cancer after coronary artery bypass grafting using the right gastroepiploic artery? Report of two cases and a review of the literature

被引：17

作者：

Konishi Y. ^{[1
]}

Suzuki K. ^{[1
]}

Wada H. ^{[1
]}

Watanabe H. ^{[1
]}

Ogura H. ^{[1
]}

Sugamori Y. ^{[1
]}

Bashar A. ^{[1
]}

Yamashita K. ^{[1
]}

Kobayashi T. ^{[1
]}

Kazui T. ^{[1
]}

机构：

[1] First Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu 431-3192

来源：

World Journal of Surgical Oncology | / 5卷 / 1期

关键词：

Gastric Cancer; Coronary Artery Bypass Grafting; Early Gastric Cancer; Gastroepiploic Artery; Complete Lymph Node Dissection;

D O I：

10.1186/1477-7819-5-54

中图分类号：

学科分类号：

摘要：

Background: Recently, the right gastroepiploic artery (RGEA) has been used in coronary artery bypass grafting (CABG) as an alternative arterial graft. Unfortunately, an increased incidence of gastric cancers has been reported after CABG using the RGEA. Handling of the RGEA during gastrectomy in these patients may cause lethal complications, which sometimes reduces the feasibility of curative dissection of lymph nodes at the base of the graft. Case presentations: We describe two cases of gastric cancer undergoing gastrectomy after CABG with the use of RGEA. To avoid the potentially fatal coronary event during gastrectomy, safe handling of the conduit including preparations for injuries and prevention of vessel spasm was performed in both cases, accompanied by an adequate monitoring of the systemic circulation. Intraoperative frozen section examination showed no lymph node metastasis around the graft in any of the cases; therefore, complete lymph node dissection at the base of the graft was not undertaken. No complications occurred during the operation. In addition to these two cases, twenty-four cases reported in the literatures were reviewed (a total of 26 cases). Ten early and 16 advanced gastric cancers were included. Among the 16 advanced gastric cancer cases, an alternative graft was employed in 8 due to the resection of an original graft to complete lymph node dissection. Mere handling of a graft often caused lethal complications suggesting that the operation should be completed by isolation of the graft. A pedicled graft harvesting via the ante-gastric route was popular. However, a skeletonized harvesting with resection of the pyloric branches of the RGEA would be better because this would interrupt the original lymph flow, which could eliminate the need for lymph node dissection and graft isolation. Among the 10 cases having early gastric cancers, 6 were found within 1.5 years after CABG. Early detection in these 6 cases was possible due to the use of gastric fiberscopic examination before and after CABG, which gave them opportunities to receive a less extensive operation such as endoscopic mucosal resection. Conclusion: Adequate intraoperative care as well as an optimal lymph node dissection considering the graft harvesting method at the first CABG leads to successful gastrectomy after CABG using the RGEA graft. Therefore, this operation should be carried out with careful management by both gastrointestinal and cardiovascular surgeons. © 2007 Konishi et al; licensee BioMed Central Ltd.

引用

共 27 条

[1]

Suma H., Wanibuchi Y., Terada Y., Fukuda S., Takayama T., Furuta S., The right gastroepiploic artery graft. Clinical and angiographic midterm results in 200 patients, J Thorac Cardiovasc Surg, 105, pp. 615-622, (1993)

[2]

Lytle B.W., Cosgrove D.M., Ratliff N.B., Loop F.D., Coronary artery bypass grafting with the right gastroepiploic artery, J Thorac Cardiovasc Surg, 97, pp. 826-831, (1989)

[3]

Takahashi T., Sawai S., Ogihara A., Yamaguchi T., Nakagawa N., Okano S., Takahashi S., An adequate Surgery for gastric cancer in view of lymph flows, Shoukaki Geka, 16, pp. 1365-1372, (1993)

[4]

Uchida N., Kawakami K., Kaku S., Kawaguchi M., Nakamitsu A., Fujii T., Five cases of gastric cancer occurred after coronary artery bypass grafting using the right gastroepiploic artery, Shoukaki Geka, 19, pp. 1621-1624, (1996)

[5]

Uchida N., Kawaue Y., Upper abdominal complications after coronary artery bypass operations using right gastroepiploic artery, J Jpn Assn Thorac Surg, 43, pp. 841-846, (1995)

[6]

Tanaka M., Terada Y., Sakamoto M., Problems of cholecystectomy for acute cholecystitis after coronary artery bypass grafting using the right gastroepiploic artery, Geka, 56, pp. 302-304, (1994)

[7]

Sugimoto M., Hasagawa H., Ogiso S., Sakamoto E., Igami T., Mori T., Distal gastrectomy in a patient with an in situ right gastroepiploic artery graft, Rinshou Geka, 63, pp. 2438-2442, (2002)

[8]

Yamabuki K., Thickness of the muscle layer of the gastroepiploic artery and the internal mammary artery-a presumable factor of flow instability in GEA during the perioperative period, J Jpn Assn Thorac Surg, 45, pp. 1725-1732, (1997)

[9]

Japanese Classification of Gastric Carcinoma, 1, (1998)

[10]

Koto K., The method of skeletonized right gastroepiploic artery is useful for following upper abdominal cancer operation, Kyobu Geka, 56, pp. 545-547, (2003)

← 1 2 3 →