RESUMO
The aim of the presented clinical observation is to demonstrate a multidisciplinary approach in the treatment of a comorbid patient with complicated colorectal cancer, multivessel coronary artery disease, degenerative aortic valve disease and chronic heart failure. The authors presented a clinical case of treatment of a patient with ischemic heart disease, postinfarction cardiosclerosis (acute myocardial infarction from 1990), hemodynamically significant intestinal bleeding, the source of which was cancer of the descending colon. Comprehensive examination revealed moderately differentiated (G2) adenocarcinoma of the descending colon cT3N1M0, stage IIIB, in combination with multivessel coronary artery disease and degenerative aortic heart disease with a predominance of stenosis (pressure gradient: Pg max - 94 mm Hg, Pg mean - 68 mm Hg) and the development of aortic valve insufficiency. Taking into account the results of the examinations, the patient is indicated for myocardial revascularization and aortic valve replacement, which implied the subsequent long-term use of anticoagulants, but this increased the risk of recurrence of fatal colonic bleeding. At the same time, performing the operation to remove the source of recurrent bleeding according to all oncological principles had high risks of cardiovascular complications intraoperatively and in the immediate postoperative period. In this regard, after an objective assessment of all perioperative risks, it was decided to simultaneously perform direct myocardial revascularization, aortic valve replacement and extended left-sided hemicolectomy with extended lymphadenectomy. The patient is monitored at the Moscow State Clinical Hospital named after S.S. Yudin after the operation for 2 years, there is no data for the progression of the oncological process. Thus, a favorable outcome in this patient was determined by a multidisciplinary approach - performing a simultaneous operation on a comorbid patient.
