Authors
Dudanov I.P.1, 2, 4, Solovyev I.A.1–3, Glebova A.V.1, 2, Fedotov L.E.1, 2, Verbickiy O.P.2, Shcheglova L.V.1, 2, Vasilchenko N.O.2, Ouni. K.1
1 St. Petersburg State Pediatric Medical University, St. Petersburg, Russia
2 City Mariinsky Hospital, St. Petersburg, Russia
3 S.M. Kirov Military Medical Academy, St. Petersburg, Russia
4 Petrozavodsk State University, Petrozavodsk, Russia
Abstract
Relevance. In modern surgical practice, simultaneous operations are becoming increasingly relevant, especially in complex clinical scenarios such as complicated locally advanced gastric cancer in combination with acute ischemic stroke. To this day, the optimal timing and surgical approach remain the subject of discussion due to the high risks of mortality and disability.
Aim. The aim is to improve patient outcomes, reduce surgical trauma, and enhance the quality of medical care – making this direction a key focus for modern surgery and oncology. On a broader scale, this work’s mission is to provide results that could serve as a foundation for international guidelines, helping to reduce mortality and improve patients’ quality of life.
Case Description. We present a clinical case of a 69-year-old male patient diagnosed with ischemic stroke in the left carotid artery territory, atherothrombotic subtype. The patient had 65% stenosis of the left internal carotid artery with signs of plaque instability, and 45% stenosis on the right. He was also diagnosed with cancer of the gastric body and cardia (cT4N0M0), complicated by tumor breakdown and gastric bleeding. A multidisciplinary medical board concluded that a simultaneous operation was the most optimal and the only tactically justified approach in this situation.
Conclusion. The topic of simultaneous surgery for locally advanced complicated gastric cancer during the acute phase of ischemic stroke is extremely original and highly relevant due to the increasing number of patients with comorbid conditions and the need for integrated surgical solutions. This clinical case may serve as a model for building an optimal surgical strategy for similar patient groups.
Keywords: gastric cancer, ischemic stroke, simultaneous surgery, endarterectomy, gastrectomy.
References
1. Kharisyanova EA, Kharisyano VI. Morbidity of the population according to the main disease classes in the regions of the Russian Federation. Ufa Humanitarian Research Forum. 2024; 4: 449–460. (In Russ.) doi: 10.47309/2713-2358-2024-4-449-460.
2. Golivets TP, Kovalenko BS. Analysis of world and Russian trends in oncological morbidity in the XXI century. Scientific Result. Series: Medicine and Pharmacy. 2015; 1(4): 125-131. (In Russ.) doi: 10.18413/2313-8955-2015-1-4-125-131.
3. Rakhmanzhanov AA, Buziashvili YI, Asymbekova EU, Borbodoeva BM. Combination of ischemic heart disease and oncology. Clinical Physiology of Circulation. 2023; 2(20): 93-106. (In Russ.) doi: 10.24022/1814-6910-2023-20-2-93-106.
4. Taccone FS, Jeannotte SM, Bledic SA. First-ever stroke as initial presentation of systemic cancer. J Stroke Cerebrovasc Dis. 2008; 17(4): 169-174.
5. Komarov RN, Osminin SV, Egorov AV, Chernyavsky SV, Zavaruev AV, Bilyalov IR, Astaeva MO. Simultaneous operations for stomach cancer, esophageal cancer, and cardiovascular diseases. Surgery. Pirogov Journal. 2023; 7: 29-36. (In Russ.) doi: 10.17116/hirurgia202307129.
6. Davydov MI, Akchurin RS, Gerasimov SS, Brand YB, Skopin II, Dolgov IM. Surgical treatment of patients with stomach cancer and severe concomitant cardiovascular pathology. Pirogov Russian Journal of Surgery. 2013; 9: 4-13.
7. Golbraykh VA, Maskin SS, Matyukhin VV, Klimovich IN, Arutyunyan AG. Modern approaches to simultaneous operations (indications, algorithms, complications). Bulletin of Volgograd State Medical University. 2021; 39: 31. (In Russ.)
8. Gruzdev VE, Gorobec ES, Davydov MM, Gerasimov SS, Tipisev DA. Anesthesiological support of simultaneous surgical interventions for cancer and severe ischemic heart disease: experience of 8 operations. Clinical and Experimental Surgery. 2015; 3: 45-49. doi: 10.24060/2313-3945-2015-3-3-45-49.
9. Gerasimov SS, Davydov MI, Davydov MM. Modern strategy for surgical treatment of oncological patients with severe concomitant cardiovascular diseases. Russian Oncological Journal. 2018; 23(3-6): 120-128. (In Russ.) doi: 10.18821/1028-99842019-23-3-6-120-128.
10. Dudanov IP, Belinskaya VG, Atamanova EE, Laptev KV, Vasilchenko NO, Koblov ES. Carotid endarterectomy in the acute period of ischemic stroke. Tomsk Oncological Journal. 2011; II(3). (In Russ.)
11. Zharova AS, Abramov OO, Golets KO, et al. Results of carotid endarterectomy in the acutest period of ischemic stroke. S.S. Korsakov Journal of Neurology and Psychiatry. 2022; 122(12-2): 55-59. doi: 10.17116/jnevro202212212255.
