Surgical procedures and follow up.
All patients were given lipid-lowering drugs and beta-blocker prior to
the operation. Except for case 2, the patients were discontinued from
clopidogrel and aspirin seven to eight days before surgery, and low
molecular weight heparin (4100 U, q12h) was injected subcutaneously for
bridging. During the bridging process, severe angina or chest tightness
did not occur in any case, nor did gastrointestinal bleeding occur. Case
2 had severe coronary artery stenosis before surgery and presented with
left heart failure, while antiplatelet drugs, cardiotonic diuretics and
other drugs did not improve the patient’s condition. After implantation
of an intra-aortic balloon pump (IABP), the blood flow was stable enough
to perform an emergency OPCAB and radical resection of the gastric
cancer.
All the patients were operated on by the same group of cardiac and
gastrointestinal surgeons. OPCAB was performed first, followed by
radical cancer resection of the gastrointestinal tumors. After
conventional anesthesia, a median incision was made into the chest to
harvest the internal mammary artery, the great saphenous vein, and the
left radial artery as graft vessels. Heparin (1 mg/kg) was administered
intravenously before the graft was disengaged. The proximal end of the
graft was sutured to the aorta using 5-0 prolene, and the distal end was
sutured to the coronary artery using 7-0 prolene. After completion of
the grafting, protamine sulfate (1.5x the amount of heparin) was
administered for heparin neutralization. After rigorous maintenance of
hemostasis and placement of a thoracic drainage tube, the chest was
closed. The abdomen was then disinfected again, and a midabdominal
incision was made approximately 5 cm from the lower edge of the chest
incision to perform the radical resection of the gastrointestinal tumor.
All patients underwent an R0 resection and standard lymph node
dissection. Negative pressure drainage was established, and gastric
cancer patients were fitted with a nasal nutrition tube (Table 3).
Following the operations, patients were placed in the intensive care
unit for monitoring. The IABP was removed shortly after the operation,
and the tracheal intubation was removed at the appropriate time.
Patients with gastric cancer received enteral nutrient solution,
aspirin, clopidogrel, beta-blockers, and lipid-lowering drugs through
the nasal feeding tube beginning from the first day after surgery.
Patients with colorectal cancer received intravenous nutrition and low
molecular weight heparin (4100 U, q12h) was injected subcutaneously from
the first postoperative day. After eating, the patients were given the
above drugs orally. The drainage tube was removed when the pleural
mediastinal drainage was less than 200 mL/day. After confirming that
there were no gastrointestinal fistulas, the abdominal drainage tube and
enteral feeding tube were removed and the patients were discharged. The
patients were prescribed additional medication and were followed up
regularly (Table 4).