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The journal «ONCOSURGERY» 2012, Vol.4, No 3

Simultaneous open heart surgery in patients with lung cancer

Porkhanov VА, Barbukhatti КО, Kononenko VB, Belash SYu, Kovalenko AL, Boldyrev SYu, Skopets АА, Sitnik SD, Polyakov IS

Regional clinical hospital №1, The centre of thoracic surgery, Krasnodar, Russia
Contact: Boldyrev SYu, e-mail:

Introduction. The surgical treatment for lung cancer remains the most efficient but with certain risk of serious complications, which multiply increase for cardiac pathology. The operative risk of lung surgery was shown to be decreased if correction of valvularpathology, open or percutaneous myocardial revascularization were performed.

Material and methods. From December 2002 to December 2011 in Ochapovskovo Regional clinical hospital №1 181 combined surgeries were performed in patients with combined disease of lung, chest wall, esophagus and heart. 145 (80%) men and 36 women received a treatment. The mean age accounted for 62±3.2 y.o. (from 29 to 76). Malignant tumors were in 148 patients (81.7%), benign – in 33 (18.3%). The approach to lung and heart was performed as single-step (simultaneously) in 148 pts (91%) or two-step – 33 pts.

Results. 181 patients underwent 46 segmental pulmonary resections, 118 lob- and bilobectomies, 9 pneumonectomies and 8 mediastinal neoplasms of different localization were removed. Accordingly 2 circumferential resections of right and left superior lobar bronchi and 1 double circumferential resection of right superior lobar bronchus and pulmonary artery and 2 pneumonectomies with circumferential resection of tracheal bifurcation (1 left and 1 right). In patients with benign tumors 2 enucleations of chondroma in inferior lobe on the left and middle lobe on the right, 2 precision removals of tuberculoma was made. For the rest machine atypical segmental resections were performed. For sternotomy neurinomas of right chest wall were removed from costovertebral angle and left-sided esophageal leiomyoma 6×8 cm in size enucleated with following plasty of esophagous. The duration of surgery accounted for 3 h 10 min ± 15 min (from 2 h 50 min to 4 h 45 min). Intraoperative complications were in 2(11%) cases in the group where lung surgery was performed after discontinuation of cardiopulmonary bypass, these complications were associated with heart rhythm disturbance during attempt for manipulations on the root of the left lung, which required discontinuation of surgery and open-chest resuscitation in one cases and defibrillation in another case. In postoperative period 3 (2%) cases of surgical bleeding occurred, 1(1.1%) patient had myocardial infarction, 2 (2.2%) patients had ischemic stroke for first 7 days after surgery, later one of them had bilateral pneumonia, renal failure. In 4 (3.2%) patients there were postoperative pneumonia, in 2 of them – pneumonia of the only lung, in 2 – bilateral pneumonia. Refractory atrial fibrillation were in 2 (2.2%) patients. One patient had non-complete incomplete fistula of right inferior lobar bronchus, complicated by pleural empyema. There was no intraoperative mortality. Postoperative mortality accounted for 5 (5.4%). The causes were as follows: pneumonia of the only lung in 2 patients, bilateral pneumonia in 1 case, stroke in 1 patients followed by multiorgan dysfunction and one myocardial infarction. It should be noticed that in the group of 18 patients without cardiopulmonary bypass during lung surgery the mortality rate was 11%, and for cardiopulmonary bypass – 4%. The difference was significant. The continuous follow-up was in 98 (66%) of 148 patients with lung cancer. The follow-up period was from 7 years to 3 months, the last operated patient was examined in December, 2011. For lung cancer the 5-year overall survival rate calculated by Kaplan-Mayer analisys [13] was 35%, median survival rate – 41 months. To assess the efficiency of revascularization 1-, 3-, 5-year angina recurrence rates were 2.6%, 4.2%, 7.5%, respectively.

Conclusion. The results show that survival rate after combined heart and lung surgery does not significantly differ from well-known rates and also is associated with stage of disease as for other cancer patients. Thus, one-step surgery on lung and heart for cancer through sternotomy under cardiopulmonary bypass is efficient surgical treatment for lung cancer and prevention of coronary death in patients with severe cardiac pathology.

KEY WORDS: lung cancer, simultaneous surgery, cardiopulmonary bypass, co-morbidity.

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