Laparoscopic colectomy after transcatheter aortic valve implantation in an elderly patient with obstructive descending colon cancer and severe aortic stenosis: a case report

Abstract

Background 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. Case presentation 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. Conclusion 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.

A case of oral cancer with preoperative transcatheter aortic valve implantation for aortic stenosis: A case report

“…However, TAVI is potentially useful for such patients. While there are several reports of cancer surgery after TAVI ( 8-12 ), to our knowledge, this is the first report of TAVI for a patient undergoing oral cancer surgery. Moreover, there is little data on the feasibility of TAVI for severe AS patients scheduled for cancer surgery and the impact on subsequent surgery.…”

“…As far as we are aware, there have been no reports of TAVI being performed before surgery for head and neck cancers. There were a few reports found of TAVI procedures performed before surgery for cancers in other parts of the body ( 8-12 ). The interval between AS treatment and cancer treatment should be short to prevent malignant tumor progression.…”

“…In addition, surgery decreases the body's natural defenses; thus, insufficient time between operations increases the risk of postoperative infection. To our knowledge, there is no report on the appropriate interval between TAVI and surgery, however, an interval of about 2-3 weeks between cancer resection surgery and TAVI was applied in colon cancer and lung cancer patients ( 8-12 ). We scheduled a similar time interval in the present case.…”

Transcatheter aortic valve implantation under lower activated clotting time in a patient with hemorrhagic gastric cancer: a case report

“…There have been a report of shorter ACT (180–200 s) being applied for TAVI in a patient with pulmonary artery pseudoaneurysm [ 6 ] and a report of TAVI being performed with a shorter ACT (180–200 s) through carotid artery access under local anesthesia in 19 patients [ 7 ]. There have been two reports of TAVI being performed in patients with malignant tumors [ 8 , 9 ]. In those reports, while the authors reported single antiplatelet therapy during malignant tumor surgery after TAVI, there was no description of ACT.…”