Introduction
Gastric cancer and colorectal malignancies, two major cancers that threaten human life, rank sixth and second in terms of global incidence of cancer, respectively, and gastric cancer ranks second in terms of mortality 1. Cardiovascular disease is the most common risk factor that complicates the radical resection of gastrointestinal tumors in elderly patients 2. In recent years, with the development of the economy and improvement in health care within China, the average life span has been significantly extended3. At the same time, the incidence of cardiovascular diseases has also increased significantly 4. The number of patients with ischemic heart disease, especially those with multiple coronary arteries severely affected by stenosis, has gradually increased 5. As such, the number of patients with gastrointestinal tumors complicated by multi-vessel coronary artery disease is also trending upwards.
Studies have confirmed that the incidence of perioperative myocardial ischemia is approximately 40% for non-cardiac surgery in cardiovascular patients/high-risk patients, which is nine times higher than low-risk patients, and postoperative negative cardiac events are significantly increased 6. Patients with coronary heart disease, especially those with multiple vessels affected, who only undergo peripheral vascular, chest and abdominal surgery without coronary revascularization, have an increased risk of myocardial infarction and cardiac death 7. Coronary revascularization can help reduce the risk of heart attack and death in these high-risk patients8. Therefore, for patients with gastrointestinal cancer complicated by severe coronary artery stenosis, it has become a difficult surgical problem to achieve complete radical resection of the tumor while reducing the risk, as much as possible, of perioperative myocardial infarction and death. This study retrospectively analyzed the data of five patients who underwent concurrent off-pump coronary artery bypass (OPCAB) and radical resection of a gastrointestinal tumor between September 2010 and October 2019, in order to provide additional insight regarding the treatment of these patients.