[Cardiac surgery with extracorporeal circulation in cancer patients: influence on surgical morbidity and mortality and on survival].
OBJECTIVE
Morbimortality related to cardiac surgery may be superior in patients with malignant neoplastic disease. Inflammatory phenomena and immunologic changes secondary to extracorporeal circulation use can also increase tumor recurrence. We evaluate characteristics and results of cardiac surgery in our neoplastic patients.


METHODS
Out of 2146 consecutive patients who underwent cardiac surgery with extracorporeal circulation, 89 (4.2%) had been previously affected by cancer. Cancer was active (recent diagnosis or under treatment) in 33 patients (group A) and 56 (group B) were in remission. Both groups were matched with 165 patients with no tumor, according to age, gender, type of surgery, and comorbidity (group C). We retrospectively evaluated incremental risk factors for surgical morbimortality, survival and tumor recurrence.


RESULTS
Median interval between cancer diagnosis and surgery was 60 months and mortality and morbidity were 4.5% and 36%, respectively, vs 5,4% and 32,7% in group C. During follow-up, 12 patients died (8 due to cancer), 16 suffered cancer recurrence and 2 new tumors were diagnosed. Statistical analysis did not permit us to identify any incremental risk factor for mortality. Postoperative morbidity was increased in case of preoperative renal failure. During follow-up, survival was significantly decreased in group A, in case of preoperative left ventricular dysfunction or pulmonary obstructive disease, and when interval between cancer diagnosis and cardiac surgery was under 2 years.


CONCLUSIONS
We have not observed an increase in cardiac surgery morbimortality in cancer patients. Anyway, survival is decreased in case of active or recently diagnosed cancer.
Carrascal
Yolanda
Y
Servicio de Cirugía Cardiaca, Instituto de Ciencias del Corazón (ICICOR), Hospital Universitario de Valladolid, Valladolid, España. ycarrascal@hotmail.com
Gualis
Javier
J
Arévalo
Adolfo
A
Fulquet
Enrique
E
Flórez
Santiago
S
Rey
Juvenal
J
Echevarría
José R
JR
Di Stefano
Salvatore
S
Fiz
Luis
L
D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures; D005112:Extracorporeal Circulation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications*; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology* / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate