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INTERRUPTED MINIMALLY INVASIVE IVOR LEWIS ESOPHAGECTOMY DUE TO INTRA-OPERATIVE COR IMPETUM (HEART ATTACK)
Olufunmilayo C. Agunloye.
Albany Medical Center, Albany, NY, USA.

OBJECTIVE: Management of high-risk cardiac patients with resectable esophageal cancer remains a challenge. Up to 10.4% undergoing esophagectomy have cardiovascular complications [1,2]. Furthermore, cardiac events are exacerbated in patients undergoing neoadjuvant chemotherapy versus surgery-alone[3]. This the first time an interrupted esophagectomy has been described.
METHODS: We present a 60-year-old male with dysphagia for 8-months. His workup consisted of an esophagram, esohagogastroduodenonscopy showing a tumor extending from 32-42 cm from the incisors. Pathology showed invasive well-differentiated adenocarcinoma. A PET scan showed with no malignant adenopathy consistent with early stage esophageal cancer that was resectable. Preoperative workup included a stress test which showed stable absent ischemic changes on EKG. He went to the operating room for a minimally invasive esophagectomy. The laparoscopic abdominal portion was unremarkable. Intraoperatively he developed ST depressions and ventricular tachycardia consistent with a myocardial infarction. The case was aborted and the patient was taken directly for heart catherization from the operating room. He had 100% left anterior descending artery occlusion. Reperfusion was performed with pecutanous stenting. He returned to the operating room the following day for completion esophagectomy and re-creation of GI continuity. He was discharged. Final pathology showed T3 N1 tumor and he received adjuvant chemotherapy. He remains without evidence of recurrent disease.
RESULTS: This case proves that esophagectomy can be completed in a delayed fashion.
CONCLUSIONS: There is a need to optimize of high risk cardiac patients and brings discussion of new options such as intra-aortic balloon pumps in patients with ischemic heart disease undergoing esophagectomy[4].


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