{
  "abstract": "Introduction: Managing patients with concurrent ampullary carcinoma and severe coronary artery disease (CAD) poses a formidable surgical dilemma. Pancreatoduodenectomy (PD) is a highly invasive procedure with significant bleeding risks, while symptomatic CAD requires urgent revascularization. Standard percutaneous coronary intervention necessitates dual antiplatelet therapy (DAPT), which increases perioperative hemorrhagic complications. However, delaying PD to complete cardiac treatment risks tumor progression. We present a strategic “ultra-short-interval” staged approach to balance oncological urgency with cardiac safety.\n\nCase Presentation: A man in his 70s presented with severe anemia (Hb 6.6 g/dL) and exertional dyspnea (CCS class III/IV). Investigations revealed stage IB ampullary adenocarcinoma and severe CAD, including 90% stenosis in the left anterior descending artery. To avoid the bleeding risks of DAPT and the systemic trauma of conventional coronary artery bypass grafting, minimally invasive direct coronary artery bypass (MIDCAB) was performed. An ultra-short-interval staged approach was strategically planned, with PD scheduled just 7 days after MIDCAB. Despite transient postoperative hematochezia after the first procedure, the patient remained stable. As planned, subtotal stomach-preserving PD was successfully performed 1 week later without cardiovascular events. The patient was discharged on postoperative day 31.\n\nConclusion: This ultra-short-interval staged approach – MIDCAB followed by PD within seven days – is a potent strategy for high-risk candidates. It facilitates essential coronary revascularization without DAPT or cardiopulmonary bypass, thereby minimizing oncological delay and tumor progression risks while mitigating the risk of catastrophic perioperative myocardial infarction or hemorrhage.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan"
  ],
  "article_type": "case report",
  "arxiv": null,
  "author_total": 7,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Tenchi Yamamoto"
    },
    {
      "affs": [
        0
      ],
      "name": "Fumiaki Watanabe"
    },
    {
      "affs": [
        0
      ],
      "name": "Yuki Mizusawa"
    },
    {
      "affs": [
        0
      ],
      "name": "Hidetoshi Aizawa"
    },
    {
      "affs": [
        0
      ],
      "name": "Yuhei Endo"
    },
    {
      "affs": [
        0
      ],
      "name": "Hiroshi Noda"
    },
    {
      "affs": [
        0
      ],
      "name": "Toshiki Rikiyama"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/ettaqv5mtr847.bib",
  "cited_by": 0,
  "doi": "10.1159/crg/abwag017",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13716405/",
  "id": "ettaqv5mtr847",
  "issns": [
    "1662-0631"
  ],
  "landing_url": "https://doi.org/10.1159/crg/abwag017",
  "language": "en",
  "licence": "CC-BY-NC-4.0",
  "licence_label": "CC BY-NC 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Single Case"
    ],
    [
      "openalex",
      "2730|Pancreatic and Hepatic Oncology Research"
    ]
  ],
  "openalex": "W7220972775",
  "pdf_url": "https://karger.com/crg/article-pdf/doi/10.1159/crg/abwag017/4592178/000554598.pdf",
  "pmcid": "PMC13716405",
  "pmid": "42953597",
  "published": "2026-10-07",
  "publisher": "Karger Publishers",
  "ris": "https://research.draconitic.com/paper/ettaqv5mtr847.ris",
  "sources": [
    {
      "first_seen": "2026-11-01T12:23:24Z",
      "native_id": "PMC13716405",
      "source": "pmc",
      "url": "https://doi.org/10.1159/crg/abwag017"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2730|Pancreatic and Hepatic Oncology Research",
      "subfield": "oncology"
    }
  ],
  "title": "Ultra-Short-Interval Staged Pancreatoduodenectomy after Minimally Invasive Direct Coronary Artery Bypass for Ampullary Carcinoma in a Patient with Severe Coronary Artery Disease: A Case Report",
  "title_text": "Ultra-Short-Interval Staged Pancreatoduodenectomy after Minimally Invasive Direct Coronary Artery Bypass for Ampullary Carcinoma in a Patient with Severe Coronary Artery Disease: A Case Report",
  "type": "peer-reviewed",
  "updated_at": "2026-11-01T12:23:24Z",
  "url": "https://research.draconitic.com/paper/ettaqv5mtr847",
  "venue": "Case Reports in Gastroenterology",
  "versions": []
}