Simultaneous Off‐Pump Coronary Artery Bypass Graft and Nephrectomy

Abstract

We report the one-stage surgical management of a 68-year-old patient with renal cell carcinoma and serious hematuria combined with coronary artery disease and unstable angina. After the accomplishment of coronary revascularization without cardiopulmonary bypass, we proceeded to nephrectomy and resection of the renal tumor at the same time. The patient's postoperative course was uneventful, and at 17 months of follow-up, the patient showed no signs of recurrence. To the best of our knowledge, such a case has never been reported before in the literature.

Simultaneously performed off-pump coronary artery bypass grafting and colectomy: a case report

“…Multiple metastases of lung cancer have been reported in patients with lung cancer being subject to cardiac surgery in the conventional way and with the use of HLM [9,10]. The same hypothesis is adopted by other authors, indicating that the combined cardiac and oncologic procedures should be performed avoiding the CPB [2,10-13]. Thus a mixture of immune activities caused by the CPB might affect the spread of the coexisting malignancy.…”

“…Neutrophils are activated [7] and also total lymphocytes, T-lymphocytes, B-lymphocytes, natural killer cells and helper T-cells show significant decrease in absolute numbers for more than one week postoperatively as compared to the preoperative values [8]. The weakness of the immune system caused by the CPB might affect the spread of the coexisting tumor [2,9]. Multiple metastases of lung cancer have been reported in patients with lung cancer being subject to cardiac surgery in the conventional way and with the use of HLM [9,10].…”

“…Off-pump coronary revascularization and nephrectomy due to malignancy has recently been reported in literature. The patient outcome was uneventful and the follow-up 17 months, did not reveal any sings of recurrence neither symptoms of angina [2]. It has been described in the bibliography a series of combined open heart surgery and lung intervention (lobectomy or wedge lung resection) simultaneously.…”

Cancer in Heart Disease Patients: What are the Limitations in the Treatment strategy?

“…However, a decreased tumor recurrence and mortality has been observed with omission of ECC [3]. This can be indirectly related to lesser dissemination of tumor cells through damaged endothelial cells and inflammation [3][4][5]19]. Improved survival in patients in whom ECC was used could be clouded by confounders; these patients were younger and had less advanced tumor stage compared with patients who underwent off-pump CABG [27].…”

“…Prior PCI/CABG might not be necessary in these patients. In high-risk patients, treatment of CAD by PCI or CABG has priority over the treatment of cancer [3,19]. Remarkably, in one series of 1067 patients operated for non-small-cell lung cancer, cardiac Box 2.…”