Surgery Against Cancer of Gastrointestinal Tract and Perioperative Management in Patients Receiving Drug-Eluting Coronary Stent Implantation

Takahisa Fujikawa, Akira Tanaka, Toshihiro Abe, Yasunori Yoshimoto, Katsuhiro Kondo¹⁾, Hiroyoshi Yokoi¹⁾, Kei Shiraishi²⁾, Tomoharu Yoshida²⁾, Katsuhiro Seo³⁾ and Masakiyo Nobuyoshi¹⁾

Department of Surgery, Department of Cardiology¹⁾, Department of Gastroenterology²⁾ and Department of Anesthethiology³⁾, Kokura Memorial Hospital

Introduction: Drug-eluting coronary stents (DES) are widely used to treat coronary heart disease, although long-term dual antiplatelet therapy with aspirin and thienopyridine are needed to prevent stent thrombosis. No evidence exists, to the best of our knowledge, of the safety of drug substitution in patients undergoing major noncardiac surgery after DES implantation. Methods: We reviewed the cases of the most recent fifteen consecutive patients undergoing surgery for gastrointestinal tract cancer following DES implantation, assessing data on preoperative status, perioperative management, and patient outcome, including postoperative bleeding and thrombotic complications. Results: Surgical indications included nine cases of gastric cancer, three of colon cancer, and three of rectal cancer. Surgery involved six partial distal gastrectomies, three total gastrectomies, three colon resections including one laparoscopic surgery, and three low anterior resections including one laparoscopic surgery. Median duration to surgery after DES implantation was 17 months. In four of the ten most recent cases, surgery was done within 12 months after DES implantation. Perioperative antithrombotic management generally consisted of continuing aspirin therapy until one day before surgery and thienopyridine therapy interruption with substitute heparin administration one week before surgery. Surgery was safe and free of perioperative stent thrombosis and severe bleeding complications. Conclusion: Under rigorous perioperative antithrombotic management, patients with gastrointestinal tract cancer were successfully treated without severe complications after DES implantation. With the number of such patients expected to increase, perioperative antithrombotic management protocols and cancer screening before DES implantation must be established.

Key words
drug-eluting coronary stent, antiplatelet therapy, gastric cancer, colorectal cancer, perioperative management

Reprint requests
Takahisa Fujikawa Department of Surgery, Kokura Memorial Hospital
1-1 Kifune, Kokurakita-ku, Kitakyushu, 803-8555 JAPAN

Accepted
January 27, 2010

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