title: Lung resection for non-small cell lung cancer after prophylactic coronary angioplasty and stenting: short- and long-term results.
abstract: OBJECTIVE
  Recent studies have reported a high incidence of perioperative in-stent trombosis with myocardial infarction (MI), in patients undergoing non-cardiac surgery, early after coronary angioplasty and stenting. The short and long-term results of surgery for non-small cell lung cancer (NSCLC) after prophylatic coronary angioplasty and stenting were analyzed.
  
  
  METHODS
  Prospective collected data were examined for postoperative complications and long-term survival in 16 consecutive patients who underwent mayor lung resection for NSCLC after prophylactic coronary angioplasty and stenting for significant coronary artery disease , from 2001 to 2008. One and two non-drug-eluting stents were placed in 75% or (25% of the patient, respectively. All patients had four weeks of dual antiplatelet therapy, that was discontinued 5 days prior to surgery and replaced by low molecular weight heparin. Patients were keep sedated and intubated overnight, according to our protocol.
  
  
  RESULTS
  There were no postoperative deaths nor MI. A patient experienced pulmonary embolism with moderate troponin release and underwent coronary angiography that showed patency of the stent. Two patients developed postoperative bleeding complications haemothorax requiring a re-thoracotomy in 1, gastric bleeding requiring blood transfusion in 1. At the mean follow-up of 30 months (range 3-95), none of the patients showed evidence of myocardial ischemia, while 5 (31%) patients died, mostly (N.=4) due to distant metastasis. The five-year survival rate was 53%.
  
  
  CONCLUSIONS
  In contrast to previous reports, lung resection after prophylactic coronary angioplasty and stenting is a safe and effective treatment for NSCLC and myocardial ischemia. The application of a refined protocol could be the key factor for improved results.
authors.affiliation: University Hospital of Siena, Siena, Italy. voltoliniluca@yahoo.it
authors.forename: L
authors.initials: L
authors.lastname: Voltolini
authors.forename: C
authors.initials: C
authors.lastname: Rapicetta
authors.forename: L
authors.initials: L
authors.lastname: Luzzi
authors.forename: P
authors.initials: P
authors.lastname: Paladini
authors.forename: C
authors.initials: C
authors.lastname: Ghiribelli
authors.forename: S
authors.initials: S
authors.lastname: Scolletta
authors.forename: M
authors.initials: M
authors.lastname: Fineschi
authors.forename: G
authors.initials: G
authors.lastname: Gotti
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D002289:Carcinoma, Non-Small-Cell Lung / Q000150:complications / Q000601:surgery*; D003324:Coronary Artery Disease / Q000150:complications / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy; D011446:Prospective Studies; D012307:Risk Factors; D015607:Stents; D016019:Survival Analysis; D016896:Treatment Outcome