Work

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

Year: 2026

Type: article

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.

Source: Case Reports in Gastroenterology

DOI: 10.1159/crg/abwag017