The influence of open-heart surgery on survival of patients with co-existent surgically amenable lung cancer (stages I and II)

Voets, A

doi:10.1016/s1010-7940(97)00235-2

Cited by 11 publications

(11 citation statements)

References 21 publications

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“…As for our finding of the second meta-analysis that combined LC and HD surgical procedures were significantly associated with higher postoperative proportions of complications, this appears to be in accordance with previous studies supporting that higher perioperative risks and overall perioperative mortality are compatible rather to simultaneous than staged cardiac and LC surgery (5,6,9,14,15,20,21). A possible explanation could be that combination of LC and cardiac surgery constitutes by itself a factor predisposing to a more severe early postoperative clinical condition attributed to increased surgical stress.…”

Section: Discussionsupporting

confidence: 92%

“…Issues investigated deal with the impact of: (I) age (1-4); (II) safety of choice for a combined or staged surgical procedure (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19); (III) on-or off-pump technique on postoperative complications occurrence (12,16,(20)(21)(22)(23)(24)(25)(26)(27); (IV) an extended surgery, due to LC infiltration in the left atrium and/or great vessels, on postoperative outcome (24,(28)(29)(30); (V) videoassisted thoracoscopic surgery (VATS) method on primary LC patients (31)(32)(33)(34)(35)(36); (VI) neo-adjuvant or adjuvant treatment (37)(38)(39)(40); and (VII) factors, other than the aforementioned ones, influencing postoperatively patients operated for primary LC and HD. These factors were: myocardial ischemia (41), arrhythmias (41,42), type of grafts selected (20), high preoperative serum level of lactate dehydrogenase (LDH) (43), low preoperative forced expiratory volume in one second ...…”

Section: Introductionmentioning

confidence: 99%

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Management and postoperative outcome in primary lung cancer and heart disease co-morbidity: a systematic review and meta-analysis

Bablekos¹,

Analitis²,

Michaelides³

et al. 2016

Ann. Transl. Med.

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Background: Co-morbidity of primary lung cancer (LC) and heart disease (HD), both requiring surgical therapy, characterizes a high risk group of patients necessitating prompt diagnosis and treatment. The aim of this study is the review of available evidence guiding the management of these patients.Methods: Postoperative outcome of patients operated for primary LC (first meta-analysis) and for both primary LC and HD co-morbidity (second meta-analysis), were studied. Parameters examined in both meta-analyses were thirty-day postoperative mortality, postoperative complications, three-and five-year survival probabilities. The last 36 years were reviewed by using the PubMed data base. Thirty-seven studies were qualified for both meta-analyses. Results:The pooled 30-day mortality percentages (%) were 4.16% [95% confidence interval (CI): 2.68-5.95](first meta-analysis) and 5.26% (95% CI: 3.47-7.62) (second meta-analysis). Higher percentages of squamous histology and lobectomy, were significantly associated with increased (P=0.001) and decreased (P<0.001) thirty-day postoperative mortality, respectively (first meta-analysis). The pooled percentages for postoperative complications were 34.32% (95% CI: 24.59-44.75) (first meta-analysis) and 45.59% (95% CI: 35.62-55.74) (second metaanalysis). Higher percentages of squamous histology (P=0.001), lobectomy (P=0.002) and p-T1 or p-T2 (P=0.034) were associated with higher proportions of postoperative complications (second meta-analysis). The pooled threeand five-year survival probabilities were 68.25% (95% CI: 45.93-86.86) and 52.03% (95% CI: 34.71-69.11), respectively. Higher mean age (P=0.046) and percentage lobectomy (P=0.009) significantly reduced the five-year survival probability.Conclusions: Lobectomy and age were both accompanied by reduced five-year survival rate. Also, combined aorto-coronary bypass grafting (CABG) with lobectomy for squamous pT1 or pT2 LC displayed a higher risk of postoperative complications. Moreover, medical decision between combined or staged surgery is suggested to be individualized based on adequacy of coronary arterial perfusion, age, patient's preoperative performance status (taking into account possible co-morbidities per patient), tumor's staging and extent of lung resection.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Management and postoperative outcome in primary lung cancer and heart disease co-morbidity: a systematic review and meta-analysis

Bablekos¹,

Analitis²,

Michaelides³

et al. 2016

Ann. Transl. Med.

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“…A point of major concern, however, is the increase in rnetastastatic disease which has been linked to the extracorporeal circulation used during open-heart surgery. Various studies have addressed this issue in patients with lung cancer and coronary disease where resection of the tumor and coronary revascularisation were done at the same time [13,14]. In our case since the tumor was in the pulmonary vein, we believed that there was not an increased risk of dissemination by using CBP.…”

Section: Discussionmentioning

confidence: 81%

Combined Surgical Approach for Sarcoma Lung Metastasis with Atrial Involvement

Torre¹,

Rábago²,

Barba³

et al. 1999

Thorac cardiovasc Surg

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A 20-year-old patient, who had been treated for a femur sarcoma with pulmonary metastases 8 years before, arrived at our institution with a new metastatic hilar lung nodule. During the standard lobectomy procedure an unexpected atrial invasion by the tumor was discovered. Intraoperative transesophageal echocardiography (TEE) showed a big pediculated tumor in the atrium. Cardiopulmonary bypass (CPB) was required in order to safely resect the atrial wall with the tumor. The atrial defect was repaired with a pericardial patch. Postoperative course was uneventful. After 14 months, the patient is asymptomatic and free of disease.

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“…A two-stage technique requires an interval in which the patient has the time to recover. This approach is safe, with a morbidity and mortality rate lower than a combined procedure (range: 3-10 vs 5.4-20.8% for mortality and 52 vs 86% for morbidity) [28][29][30][31]. The main drawback, however, is the delay of the treatment for cancer, which might result in its progression to an incurable disease.…”

Section: Coronary Artery Bypass Graftingmentioning

confidence: 99%

“…This could be attributed to inadequate access to lymph nodes. As an alternative, a posterolateral thoracotomy [30] or a T-shaped sternotomy with anterolateral extension through the fifth intercostal space [70] is effective for CABG, resection and lymph node dissection [3].…”

Section: The Ecc and The Immune Systemmentioning

confidence: 99%

Cancer in Heart Disease Patients: What are the Limitations in the Treatment strategy?

Mistiaen

2013

Future Cardiol.

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Cardiovascular disease and cancer are leading causes of morbidity and mortality, and can both be present in one patient. In patients with simultaneous disease, the most threatening disease should be treated first. This is usually heart disease, but this can pose specific problems. If percutaneous coronary intervention is preferred, bleeding and thrombotic tendencies have to be taken into account in the subsequent treatment of the malignancy. With coronary artery bypass grafting, the advantages and disadvantages of one- or two-stage procedures, and the use of extracorporeal circulation have to be balanced. Development of heart disease after treatment of malignancy could be due to radiotherapy and chemotherapy. The effects of these cancer treatments have to be taken into account for the treatment options of the heart disease and the postoperative prognosis.

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The influence of open-heart surgery on survival of patients with co-existent surgically amenable lung cancer (stages I and II)

Cited by 11 publications

References 21 publications

Management and postoperative outcome in primary lung cancer and heart disease co-morbidity: a systematic review and meta-analysis

Management and postoperative outcome in primary lung cancer and heart disease co-morbidity: a systematic review and meta-analysis

Combined Surgical Approach for Sarcoma Lung Metastasis with Atrial Involvement

Cancer in Heart Disease Patients: What are the Limitations in the Treatment strategy?

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