Ultra–short-interval staged pancreatoduodenectomy after minimally invasive direct coronary artery bypass for ampullary carcinoma in a patient with severe coronary artery disease: a case report

Introduction

Managing patients with concurrent ampullary carcinoma and severe coronary artery disease (CAD) poses a formidable surgical dilemma. Pancreatoduodenectomy (PD) is a highly invasive procedure with significant bleeding risks, while symptomatic CAD requires urgent revascularization. Standard percutaneous coronary intervention (PCI) necessitates dual antiplatelet therapy (DAPT), which increases perioperative hemorrhagic complications. However, delaying PD to complete cardiac treatment risks tumor progression. We present a strategic “ultra-short-interval” staged approach to balance oncological urgency with cardiac safety.