Synchroneously occurring lung cancer (stages I-II) and coronary artery disease: concomitant versus staged surgical approach.

OBJECTIVE: The assessment of the best surgical approach in patients with synchroneously occurring lung cancer (stages I and II) and coronary artery disease: concomitant or staged. METHODS: A retrospective, observational study was conducted in a tertiary centre for cardiothoracic surgery. From 1988-1995, 34 patients underwent pulmonary resection for stages I-II primary bronchogenic carcinoma and open-heart surgery (almost always coronary-artery bypass grafting), either concomitantly (n = 24) or in a staged procedure (n = 10). Mean interval between operations was 33.9 +/- 34.7 days (range: 12-120 days). Results were statistically computed. RESULTS: Preoperatively both groups were perfectly matched. Follow-up was 100%. Long term survival, median 4.2 years, was comparable in both groups (log-rank test: chi2 0.30; df = 1; P = 0.58), indicating no influence on survival from performing either a concomitant or staged procedure. No relation could be demonstrated between survival and age, histopathology or extent of tumour; nor in the concomitantly operated group between survival and timing of lung resection in relation to extra-corporeal circulation. Overall peri-operative mortality was 6/34, 17.6%, but a large difference was noted between the two groups (5/24, 20.8% vs. 1/10, 10%; P = 0.64), underscoring the greater risk involved in the concomitant procedure, although this difference was not statistically significant because of small numbers. CONCLUSIONS: No difference in survival between the two groups, one operated upon in a staged procedure, the other concomitantly, could be demonstrated. However, the greater perioperative risk makes the concomitant procedure less attractive, and the staged approach the preferred one. Interval between operations can be individualized according to the clinical status of the particular patient to a period as short as 2 weeks.

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

OBJECTIVE: The evaluation of the influence of open-heart surgery on the survival of patients with co-existent surgically amenable lung cancer stages I and II. METHODS: A retrospective, observational study was conducted in a tertiary centre for cardiothoracic surgery. From 1988 to 1995, 121 consecutive patients underwent pulmonary resection for stages I-II primary non-small cell bronchogenic carcinoma. Eighty seven of them had merely a lung carcinoma necessitating resection, 34 had in addition defined coronary-artery disease and consequently were also subjected to open-heart surgery. Results were statistically computed. RESULTS: Follow-up was complete in 117/121 patients, 96.7% (83/87, 95.4% and 34/34, 100% in respective groups). Both groups were matched with regard to preoperative features possibly influencing survival. Median long term survival time was 4.3 years overall, 5.8 years for patients merely undergoing lung resection and 4.2 years for them undergoing open-heart surgery as well; this difference was not statistically significant (log-rank test: chi2 0.92, df= 1, P = 0.34), indicating no or limited influence of open-heart surgery on survival of patients with surgically amenable co-existent lung carcinoma. No relationship was found between survival and age, tumour stage, and histopathology. However, metastatic disease as cause of death was significantly increased in patients undergoing open-heart surgery (5/8 vs. 10/33, P = 0.0898), indicating a possible promotion of metastatic spread of co-existent lung carcinoma by this procedure. Overall perioperative mortality rate was 10/121, 8.3%, for the greater part the result of a relatively high mortality rate in the group of patients undergoing heart as well as lung surgery (6/34, 17.6%), underscoring the great risks involved in these patients, the mortality rate for lung resection alone being comparably low 4/87, 4.6% (P = 0.0191). CONCLUSION: Open-heart surgery for defined coronary-artery disease in patients with surgically amenable lung carcinoma carries a substantially higher perioperative risk, but has no influence on long term results. Metastatic spread is possibly promoted by open-heart surgery. Optimal treatment, consisting of complete revascularization and appropriate lung resection, is therefore sufficiently justified by these results.