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
- 1Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
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.
Case 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.
Conclusion: 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.
Related
- Ampullary Neuroendocrine Carcinoma Presenting with Clinically Confirmed Endogenous Hyperinsulinemic Hypoglycemia
- Transaxillary valve surgery: innovation through simplicity in minimally invasive cardiac surgery
- Transaxillary minimally invasive mitral valve surgery: early and mid-term outcomes in 763 patients
- Optimal surgical approaches to minimally invasive myomectomy for the fertility patient.
- Minimally invasive beating-heart mitral valve surgery: How I do it
BibTeX
@article{yamamoto2026ultrashortinterval,
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}},
author = {Tenchi Yamamoto and Fumiaki Watanabe and Yuki Mizusawa and Hidetoshi Aizawa and Yuhei Endo and Hiroshi Noda and Toshiki Rikiyama},
journal = {Case Reports in Gastroenterology},
year = {2026},
month = oct,
doi = {10.1159/crg/abwag017},
url = {https://doi.org/10.1159/crg/abwag017},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - 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
AU - Tenchi Yamamoto
AU - Fumiaki Watanabe
AU - Yuki Mizusawa
AU - Hidetoshi Aizawa
AU - Yuhei Endo
AU - Hiroshi Noda
AU - Toshiki Rikiyama
PY - 2026
DA - 2026/10/07
JO - Case Reports in Gastroenterology
DO - 10.1159/crg/abwag017
UR - https://doi.org/10.1159/crg/abwag017
AB - 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. Case 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. Conclusion: 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.
SN - 1662-0631
ER -