title: Curative Resection Following Neoadjuvant Chemotherapy for Advanced Gastric Cancer With Preservation of a Right Gastroepiploic Artery Coronary Artery Bypass Graft: A Case Report.
abstract: Recently, the right gastroepiploic artery (RGEA) has been used in coronary artery bypass graft (CABG) as an alternative arterial graft. Because of the improvement of prognosis after CABG, malignant diseases are more common in older patients. However, there is a serious problem in patients with gastric cancer after CABG with RGEA graft. In these patients, an interruption of coronary blood supply through the RGEA may cause a life-threatening myocardial ischemia. Therefore, an appropriate strategy is very important to avoid risk while retaining the curability of the operation. We herein describe a 76-year-old Japanese man with advanced gastric cancer who underwent CABG using the RGEA. Abdominal computed tomography (CT) showed #6 lymph nodes (sub-pyloric lymph nodes) metastases surrounding the RGEA. We concluded that curative resection was impossible while preserving the RGEA and started combination chemotherapy using S-1 and cisplatin. After 2 courses of that, #6 lymph nodes were reduced extremely. Thereafter the patient underwent distal gastrectomy with regional lymph node dissection around the RGEA without excision of the RGEA. Histologically, there were no metastases in #6 lymph nodes. Neoadjuvant chemotherapy may be effective for preserving the RGEA graft in a patient with advanced gastric cancer after CABG.
authors.affiliation: 1 Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Suzuki
authors.affiliation: 1 Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.
authors.forename: Kyoichi
authors.initials: K
authors.lastname: Ogata
authors.affiliation: 1 Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.
authors.forename: Norimichi
authors.initials: N
authors.lastname: Kogure
authors.affiliation: 1 Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.
authors.forename: Akiharu
authors.initials: A
authors.lastname: Kimura
authors.affiliation: 1 Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Toyomasu
authors.affiliation: 2 Department of Surgery, Chichibu Hospital, Chichibu, Saitama, Japan.
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Ohno
authors.affiliation: 3 Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan.
authors.forename: Erito
authors.initials: E
authors.lastname: Mochiki
authors.affiliation: 1 Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kuwano
mesh_terms: D000368:Aged; D001026:Coronary Artery Bypass; D005743:Gastrectomy; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D009203:Myocardial Infarction / Q000601:surgery*; D020360:Neoadjuvant Therapy; D013270:Stomach / Q000098:blood supply*; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000601:surgery*; D014057:Tomography, X-Ray Computed
keywords: CABG; RGEA bypass graft; gastric cancer; neoadjuvant chemotherapy