title: Surgery on extracorporeal circulation in early and advanced non-small cell lung cancer.
abstract: BACKGROUND
  Locally advanced (T4) non-small cell lung cancer (NSCLC) is principally amenable to surgery. For radical resection of cardiovascular structures, extracorporeal circulation (ECC) may be required. Tumor dissemination is a concern in this situation. In this study, we evaluate the long-term results of T4 NSCLC surgery with ECC and compare them with combined cardiopulmonary surgery for early-stage NSCLC and heart disease.
  
  
  METHODS
  We retrospectively analyzed 16 patients undergoing surgery on ECC over a 13-year period. Eight patients suffered from T4 NSCLC (group A), and another eight patients suffered from coincidental T1-T2 NSCLC and heart disease (group B).
  
  
  RESULTS
  In group A, five patients received neoadjuvant radiochemotherapy. Complete resection was achieved in all patients. Thirty-day mortality was one patient (12.5%) in each group. Six patients died from recurrent cancer with a median survival of 13.6 months in group A. Prognosis in patients with direct tumor invasion of the aortopulmonary window was a lot worse compared to those with atrial infiltration. One T4 patient who had only received surgery survived for 155 months without relapse. In group B, no NSCLC relapse occurred, and median survival was 21.6 months. All but one death in group B occurred due to cardiovascular incidents.
  
  
  CONCLUSIONS
  Surgery on ECC for T4 NSCLC gives satisfactory results. The site of infiltration appears to be most important for local tumor relapse. Long-term survival is possible in some cases. Simultaneous cardiac and pulmonary surgery resulted in good early and midterm outcomes without surgery-induced tumor propagation.
authors.affiliation: Department of Thoracic, Cardiac and Vascular Surgery, University Hospital of Tübingen, Tübingen, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Kauffmann
authors.forename: Tobias
authors.initials: T
authors.lastname: Krüger
authors.forename: Hermann
authors.initials: H
authors.lastname: Aebert
mesh_terms: D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000401:mortality; D059186:Chemoradiotherapy, Adjuvant; D005112:Extracorporeal Circulation / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006331:Heart Diseases / Q000150:complications / Q000401:mortality / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D011013:Pneumonectomy / Q000009:adverse effects / Q000401:mortality; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome