Concomitant cardiac and pulmonary operations for lung cancer

From 1973 through 1990, 21 patients (17 men and 4 women) underwent concomitant cardiac operation and pulmonary resection for lung cancer. The mean age was 65.3 years (range, 50 to 80 years). Eighteen patients underwent coronary artery bypass; 1 underwent coronary bypass and mitral valve replacement; 1, aortic valve replacement; and 1, left ventricular aneurysmectomy. Pulmonary procedures included 16 lobectomies, 3 segmentectomies, and 2 wedge resections. Nine resections were performed during cardiopulmonary bypass, and 12 were performed either before or after bypass. On final pathologic diagnosis, 11 patients had adenocarcinoma, 7 had squamous cell carcinoma, and 3 had undifferentiated lesions. Twelve patients were in cancer stage 1 and 9 were in stage II. Placement of an intraaortic balloon pump was required in 3 patients. No patient sustained excessive blood loss requiring reoperation. Only 2 incidents (9.5%) of disseminated infection were reported. The overall 1-year survival rate was 90.5% and the 5-year survival rate was 52.4%. We found concomitant cardiac operation and pulmonary resection for lung cancer to be a safe and effective alternative to staged treatment in patients not requiring a pneumonectomy. Combined cardiac and pulmonary surgery spares the patient the risk and cost of a 2nd major surgical procedure without compromising long-term survival.