Is lung cancer surgery justified in patients with coronary artery disease?
Between 1987 and 1992, 21 patients who presented with potentially resectable non-small cell lung cancer and coronary artery disease, underwent a preoperative cardiac catheterization in order to assess the coronary artery anatomy and left ventricular function. There were 20 men and 1 woman whose ages ranged from 57 to 77 years. Patients with triple-vessel disease and poor distal circulation or impaired ventricular function (n = 2) were excluded from myocardial revascularization and pulmonary surgery. Patients with a curable left-main or triple-vessel disease (group I) first underwent surgical (n = 3) or transluminal (n = 4) myocardial revascularization. The remaining patients presented with single- or double-vessel disease, and were operated on without prior myocardial revascularization (group II; n = 12). The thoracic procedures consisted of exploratory thoracotomy in two cases, lung-sparing resection in one, lobectomy in ten, bilobectomy in one and pneumonectomy in five. The overall mortality and morbidity rates were 5.3% and 31.6%, respectively. Four patients (21%) experienced postoperative cardiac complications: fatal myocardial infarction (n = 1) and dysrhythmia (n = 2) in three group II patients (25%), and transient myocardial ischemia in one group I patient (14.3%). The overall survival rate at 5 years was 57.4% for the 17 patients who underwent resection of their cancer. We conclude that 1) lung surgery in patients with non-small cell lung cancer and coronary artery disease is justified in selected cases, 2) previous myocardial revascularization appears to confer protection against the development of postoperative cardiac morbidity.
Thomas
P
P
Department of Thoracic Surgery, Sainte-Marguerite Hospital, Marseille, France.
Giudicelli
R
R
Guillen
J C
JC
Fuentes
P
P
D000230:Adenocarcinoma / Q000150:complications / Q000601:surgery; D000368:Aged; D018287:Carcinoma, Large Cell / Q000150:complications / Q000601:surgery; D002289:Carcinoma, Non-Small-Cell Lung / Q000150:complications / Q000401:mortality / Q000601:surgery*; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000601:surgery; D003327:Coronary Disease / Q000150:complications* / Q000601:surgery; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization; D011013:Pneumonectomy; D011183:Postoperative Complications; D011379:Prognosis