# Feasibility and safety of surgery for coronary artery disease and gastrointestinal malignancy: a propensity score matching analysis

## TL;DR

This study shows that combined heart and gastrointestinal cancer surgery is safe and feasible for carefully selected patients.

## Contribution

The study provides evidence for the safety and feasibility of combined CABG and gastrointestinal cancer surgery using propensity score matching.

## Key findings

- Combined CABG and gastrointestinal cancer surgery had similar outcomes to CABG alone in most perioperative metrics.
- No cardiac adverse events or surgical complications occurred in the combined surgery group.
- Long-term follow-up showed low tumor recurrence and no cardiac issues in most patients.

## Abstract

The treatment strategy for severe coronary artery disease (CAD) combined with gastrointestinal malignant tumors remains controversial. This study aimed to explore the feasibility and safety of surgical treatment for severe CAD and gastrointestinal malignant tumors.

From January 2018 to May 2025, eight patients with severe CAD and gastrointestinal cancer underwent surgical treatment at our institution. A propensity score matching analysis was performed to balance baseline characteristics between the CABG group (group 1) and the CABG + tumor resection (TR) group (group 2). The surgical procedures and preliminary outcomes of both groups were compared, along with survival status and cardiac adverse events during follow-up.

Eight cases of gastrointestinal malignant tumors combined with CAD were identified, with seven patients undergoing off-pump CABG and gastrointestinal cancer radical resection in single stage or staged (one case received chemotherapy). 67 cases of isolated off-pump CABG were subjected to propensity score matching analysis, with a 1:1 matching ratio to compare perioperative outcomes between the two groups. Patients were followed up for postoperative cardiac adverse events, tumor recurrence, and survival time. Except for surgical duration, there were no significant differences between the two groups in 24-h drainage, intraoperative blood transfusion, ventilator support time, ICU stay duration, postoperative hospital stay duration, perioperative myocardial infarction, stroke, and ARDS (p > 0.05). All patients were discharged in good condition, without perioperative infections, or anastomotic leaks. At follow-up ranging from 2 to 45 months (mean 19 months), one colorectal cancer patient died suddenly during chemotherapy 15 months postoperatively, and one gastric lymphoma patient died from lymphoma recurrence 41 months postoperatively. The remaining patients did not experience tumor recurrence or metastasis, and no cardiac adverse events occurred.

For patients with severe CAD and gastrointestinal tumors, Off-Pump CABG and gastrointestinal cancer radical surgery is safe and feasible. Selecting appropriate patients for surgery can achieve good clinical outcomes.