Immediate and long-term survival after surgery for lung cancer in heart transplant recipients.
BACKGROUND
Lung cancer observed after heart transplantation is considered to have a poor prognosis. However, the results of surgical treatment have not yet been significantly evaluated. This retrospective study analyzed the immediate and long-term results after surgery.


METHODS
From May 1990 to December 2003, 25 heart transplant recipients underwent surgery for lung cancer. There were 22 men and 3 women, the mean age was 60.7 years (49-72). All patients had a smoking history. Lung tumors were discovered by routine chest roentgenograms and computed tomography scans in 17 patients (68%), because of clinical symptoms in 7 (28%), and incidentally in 1 (4%). The surgical procedures consisted of 23 lobectomies and 2 wedge resections.


RESULTS
The mean postoperative hospital stay was 14.2 days (5-34). The morbidity rate was 28% (n = 7 patients). The mortality rate was 12% patients (n = 3 patients). The postoperative complications in 7 of 10 patients were mainly from infectious origin. Five-year survival rate was 40.9% with a median survival of 45 months. Seven patients died during follow-up (3 from cancer and 4 from other diseases). Significant better survival was observed in N0 patients than in N+ patients (median survival of 56.8 months in N0 vs 13.5 months in N+ patients (p = 0.017).


CONCLUSIONS
Long-term results after surgery were satisfactory in early stage disease, despite a high risk for postoperative infection. Our results underline the efficiency of a close follow-up for transplant recipients with a smoking history, leading to cancer detection at an early stage.
Bagan
Patrick
P
Department of Thoracic Surgery, Georges Pompidou European Hospital, Paris V University, Paris, France. patrick.bagan@hop.egp.ap-hop-paris.fr
Assouad
Jalal
J
Berna
Pascal
P
Souilamas
Redha
R
Le Pimpec Barthes
Françoise
F
Riquet
Marc
M
D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis / Q000209:etiology / Q000401:mortality* / Q000556:secondary / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D005260:Female; D005500:Follow-Up Studies; D016027:Heart Transplantation / Q000009:adverse effects* / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay; D008175:Lung Neoplasms / Q000175:diagnosis / Q000209:etiology / Q000401:mortality* / Q000601:surgery*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate