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The early and late results of combined off-pump coronary artery bypass grafting and pulmonary resection in patients with concomitant lung cancer and unstable coronary heart disease

Wojciech Dyszkiewicz^_*, Marek Jemielity, Cezary Piwkowski, Mariusz Kasprzyk, Bartomiej Perek, Lukasz Gasiorowski, Elbieta Kaczmarek

Department of Thoracic Surgery, Karol Marcinkowski University of Medical Sciences, 62 Szamarzewski St., 60-569 Poznan, Poland

Received 16 January 2008; received in revised form 9 May 2008; accepted 19 May 2008.

^_* Corresponding author. Tel.: +48 61 66 54 349; fax: +48 61 66 54 353. (Email: dyszkiewicz{at}wp.pl).

Objective: The aim of this study was to analyze the early and long-term results of simultaneous surgical treatment of both coronary heart disease (CHD) and lung cancer. Methods: Twenty-five patients with the diagnoses of both non-small cell lung cancer (NSCLC) and unstable angina were operated on between 2001 and 2006 in the Department of Cardiothoracic Surgery at the University of Medical Sciences in Pozna, Poland. Myocardial revascularization was performed simultaneously with the lung resection. The mean patient age was 63 years. The majority (18 patients) were male and the stage of lung cancer was predominantly AJCC II. Most of the patients were classified as stage II or III CCS and the predominant pathology was a two-vessel disease. Fifteen lobectomies, six pneumonectomies and four wedge resections were performed together with the aortocoronary graft implantation (mean: 1.9 graft per patient). Results: There were no postoperative deaths or perioperative myocardial infarctions (MI). The most frequent complications were as follows: atrial fibrillation (24%), atelectasis (12%) and residual pneumothorax (12%). All the patients were followed up for 8–60 months. Within this period, eight patients (32%) died, mostly due to the cancer relapse. The local recurrence of lung cancer and distant metastases were the only factors statistically influencing the late survival. No patient in the entire follow-up period had a MI. In three patients, the symptoms of recurrent angina occurred and one of them underwent a coronary stent implantation. Conclusions: Simultaneous off-pump myocardial revascularization and lung resection is a safe and effective treatment when unstable CHD and lung cancer coexist. In selected patients, this combined procedure may be an alternative to the two-stage approach, surgical or non-surgical (cardiologic) interventions preceding the pulmonary resection. The only statistically significant factor having an impact on long-term survival is the recurrence of the cancer.

Key Words: Lung cancer • Off-pump CABG • Concomitant cardiothoracic operations