Lung cancer resection with concurrent off-pump coronary artery bypasses: safety and efficiency

Abstract

Background: To assess the safety and efficacy of combined surgery for patients with concurrent lung cancer and severe coronary heart disease (CHD). Methods: Between 2003 and 2014, 34 patients with stage I or II lung cancer and simultaneous severe CHD underwent combined off-pump coronary artery bypass (OPCAB) grafting and lung resection. Surgically, myocardial revascularization was performed first and followed by lobectomies through the same or a second incision. Video-assisted thoracoscopes were used in some cases. Five patients also received chemotherapy before or after combined surgery in an effort to improve the long-term survival. Results: All patients survived the operation and no new myocardial infarctions (MIs) occurred in the perioperative period. The most frequent complications were cardiac arrhythmias (5 cases), atelectasis (4 cases), and pulmonary infections (2 cases). All patients were followed up for 5-60 months. Within this period, 6 patients (17.6%) died due to cancer recurrence. The 3-and 5-year survivals were 75% and 67% for these lung cancer patients, respectively. Conclusions: Combined OPCAB and pulmonary resection for early stage lung cancer patients with concurrent severe CHD is a relatively safe and effective treatment with satisfactory long-term survival rates, especially for those patients with three-vessel disease who are not usually candidates for percutaneous coronary intervention (PCI) before open surgery.

Should Cardiac Surgery and Lung Cancer Be Operated Simultaneously?

“…In the lung field, haemorrhagic foci are commonly observed in the resection field and in the lymph node dissection locations. The re-operation rates linked to haemorrhage are 5-15% (1,5,10,11) . In our study, none of our cases had haemorrhage that may have required a postoperative re-operation.…”

“…Cardiac surgery (CS) and lung cancer (LC) are rarely encountered simultaneously. In 10% of LC cases, coronary artery disease is observed (1) . LC is frequently encountered with CS in preoperative tests and should not be primarily operated upon due to high cardiac risks, which are particularly dangerous risks while performing two-stage surgery.…”

Perioperative outcomes of combined heart surgery and lung tumor resection: A systematic review and meta-analysis

“…A total of 29 eligible studies were nally included in the present metaanalysis (3,(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35). These studies were carried out in the following geographical regions: ve in USA (8,19,20,32,35), four in China (3,11,25,26), four in Netherlands (7,13,30,33), three in Italy (14,18,29), two in Czech Republic (12,24), two in Japan (10,16), two in Turkey (9, 15), one in Australia (34), one in Belgium (6), one in C...…”

“…In the subgroups classi ed by heart surgery procedures, 10 studies (3,9,11,14,15,18,26,28,30,34) contained 123 patients who received combined coronary artery bypass grafting (CABG) surgery and lung tumor resection, while the other 19 studies (5-8, 10, 12, 13, 16, 17, 19, 20, 24, 25, 27, 29, 31-33, 35) enrolled both CABG surgery and other types of heart surgery procedures. Because CABG surgery and other types of heart surgery procedures were analyzed together in the 19 studies (5-8, 10, 12, 13, 16, 17, 19, 20, 24, 25, 27, 29, 31-33, 35), further assessment of heart surgery procedures other than CABG was not done.…”

“…Treatment options include either simultaneous or staged surgical procedures (4)(5)(6)(7)(8). Without postponing the treatment of either heart or lung diseases, simultaneous surgery can solve heart and lung lesions at the same time, thus avoiding the second operation (3,(9)(10)(11)(12). But, concern exists regarding the potentially increased mortality and complication rate of simultaneous surgery and the adequacy of lung exposure during heart surgery (8,(12)(13)(14)(15)(16)(17)(18)(19)(20).…”