How do we manage the gastrectomy for gastric cancer after coronary artery bypass grafting using the right gastroepiploic
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Case report
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 Yukiko Konishi, Koichi Suzuki*, Hidetoshi Wada, Hiroshi Watanabe, Hiroyuki Ogura, Yuno Sugamori, Abul Hasan Muhammad Bashar, Katsushi Yamashita, Toshihiko Kobayashi and Teruhisa Kazui Address: First Department of Surgery, Hamamatsu University School of Medicine 1-20-1, Handayama, Hamamatsu, 431-3192, Japan Email: Yukiko Konishi - [email protected]; Koichi Suzuki* - [email protected]; Hidetoshi Wada - [email protected]; Hiroshi Watanabe - [email protected]; Hiroyuki Ogura - [email protected]; Yuno Sugamori - [email protected]; Abul Hasan Muhammad Bashar - [email protected]; Katsushi Yamashita - [email protected]; Toshihiko Kobayashi - [email protected]; Teruhisa Kazui - [email protected] * Corresponding author
Published: 17 May 2007 World Journal of Surgical Oncology 2007, 5:54
doi:10.1186/1477-7819-5-54
Received: 19 October 2006 Accepted: 17 May 2007
This article is available from: http://www.wjso.com/content/5/1/54 © 2007 Konishi et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract 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
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