Tamai Koki, Okamura Shu, Kitahara Tomohiro, Minoji Takayuki, Takabatake Hiroyuki, Watanabe Noriyuki, Yamamura Noriyuki, Fukuchi Nariaki, Ebisui Chikara, Yokouchi Hideoki, Tsuda Masaki, Mizote Isamu, Kinuta Masakatsu
Department of Surgery, Suita Municipal Hospital, Kishibeshinmachi 5-7, Suita, Osaka, 564-8567, Japan.
Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Yamadaoka 2-2, Suita, Osaka, 565-0871, Japan.
Surg Case Rep. 2019 Jun 24;5(1):102. doi: 10.1186/s40792-019-0662-1.
The demand for laparoscopic colectomy is increasing due to greater number of elderly colon cancer patients, and it is important to evaluate existing comorbidities to ensure perioperative safety. Aortic stenosis (AS) is one of the most common heart diseases in the elderly, and elderly cancer patients with severe AS may be considered ineligible for optimal cancer treatment if they cannot endure surgical aortic valve replacement (SAVR). Recently, transcatheter aortic valve implantation (TAVI) has become a valid option in patients who are high risk for SAVR. We herein present the first case of an elderly cancer patient with severe AS who underwent laparoscopic colectomy after TAVI.
An 87-year-old woman with a history of multiple cardiovascular diseases was diagnosed with obstructive descending colon cancer and initially underwent colonic stenting. However, as preoperative echocardiography revealed severe AS, she underwent TAVI prior to the colectomy to reduce perioperative risk. TAVI was chosen instead of SAVR due to high SAVR mortality risk, and laparoscopic colectomy was performed 22 days after TAVI. Her postoperative course was uneventful, and she was discharged 14 days later without any deterioration in general condition. No recurrence was observed at more than 1 year, even without adjuvant therapy.
TAVI facilitated subsequent laparoscopic colectomy in an elderly cancer patient with severe AS. Our case report shows that TAVI may enable further cancer treatment even in patients with severe AS, who may otherwise be considered not suitable for such treatments.
由于老年结肠癌患者数量增加，腹腔镜结肠切除术的需求不断上升，评估现有的合并症以确保围手术期安全非常重要。主动脉瓣狭窄（AS）是老年人中最常见的心脏病之一，如果患有严重AS的老年癌症患者无法耐受外科主动脉瓣置换术（SAVR），可能会被认为不适合接受最佳癌症治疗。最近，经导管主动脉瓣植入术（TAVI）已成为SAVR高风险患者的有效选择。我们在此报告首例患有严重AS的老年癌症患者在TAVI后接受腹腔镜结肠切除术的病例。
一名有多种心血管疾病史的87岁女性被诊断为梗阻性降结肠癌，最初接受了结肠支架置入术。然而，由于术前超声心动图显示严重AS，她在结肠切除术前行TAVI以降低围手术期风险。由于SAVR死亡风险高，选择了TAVI而非SAVR，并在TAVI后22天进行了腹腔镜结肠切除术。她的术后过程顺利，14天后出院，一般状况无任何恶化。即使未接受辅助治疗，1年多来也未观察到复发。
TAVI为一名患有严重AS的老年癌症患者进行后续腹腔镜结肠切除术提供了便利。我们的病例报告表明，即使是患有严重AS的患者，TAVI也可能使他们能够接受进一步的癌症治疗，否则这些患者可能被认为不适合此类治疗。
