title: The impact of cardiovascular comorbidity on the outcome of surgery for stage I and II non-small-cell lung cancer.
abstract: OBJECTIVE
  The association between lung malignancy and cardiovascular disease has been frequently reported though its therapeutic and prognostic implications not thoroughly analyzed. This study aims at assessing the possible impact of coexisting cardiovascular disease on the outcome of surgical treatment of non small cell lung cancer (NSCLC).
  
  
  METHODS
  Among 247 consecutive patients undergone surgery for stage I and II NSCLC between 1990 and 1997, 34 (13.7%) had a cardiovascular comorbidity going to be treated by surgery, namely coronary artery disease (n=14), carotid stenosis (n=21), abdominal aortic aneurysm (n=9) and lower limbs arteriopathy (n=7). Among 22 patients (64.7%) who underwent cardiac/vascular surgery first, operation was performed after a median interval of 4.5 weeks. In five of this subset lung cancer was incidentally detected. In the other patients the cardiovascular disease was diagnosed and treated after the lung cancer had been detected and operated with a median interval of 3.5 months from thoracic procedure. Surgical procedures for lung cancer were three pneumonectomies, 12 lobectomies, 19 wedge resections. Uni and multivariate analysis for risk factors was carried out.
  
  
  RESULTS
  In the group with cardiovascular comorbidity overall postoperative mortality was 9%, while morbidity rate was 58.8%, both of them primarily caused by cardiovascular disease and significantly higher for major resections. The 3- and 5-year survival rates were 54.8% and 35.5% compared to 69.2% and 56.4% among patients without cardiovascular comorbidity (P=0.01) while the timing of vascular surgery (before or after thoracic procedure) did not significantly affect survival. Multifocal vascular disease resulted the only positive factor at multivariate analysis (P=0.005, Odd Ratio=3.51, 95% Confidence Interval=1.4-8.4).
  
  
  CONCLUSIONS
  Cardiovascular disease seems to have significant impact on survival and morbidity in patients undergone surgery for lung cancer, especially in presence of multifocal vascular disease and following major resections. The timing of vascular surgery and the extension of resection should rely on the severity of vascular disease, anaesthesiologist's and surgeon's final evaluation.
authors.affiliation: Department of Thoracic Surgery, Tor Vergata University, Rome, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Ambrogi
authors.forename: Eugenio
authors.initials: E
authors.lastname: Pompeo
authors.forename: Stefano
authors.initials: S
authors.lastname: Elia
authors.forename: Giuseppe Raimondo
authors.initials: GR
authors.lastname: Pistolese
authors.forename: Tommaso Claudio
authors.initials: TC
authors.lastname: Mineo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D015996:Survival Rate; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000150:complications* / Q000601:surgery