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Synchroneously occurring lung cancer (stages I-II) and coronary artery disease: concomitant versus staged surgical
A J Voets1, K S Joesoef, M E van Teeffelen
1Department of Pulmonology, Thoraxcentrum, Medisch Centrum de Klokkenberg, Breda, The Netherlands.
Objective:
The assessment of the best surgical approach in patients with synchroneously occurring lung cancer (stages I and II) and coronary artery disease: concomitant or staged.
Methods:
A retrospective, observational study was conducted in a tertiary centre for cardiothoracic surgery. From 1988-1995, 34 patients underwent pulmonary resection for stages I-II primary bronchogenic carcinoma and open-heart surgery (almost always coronary-artery bypass grafting), either concomitantly (n = 24) or in a staged procedure (n = 10). Mean interval between operations was 33.9 +/- 34.7 days (range: 12-120 days). Results were statistically computed.
Results:
Preoperatively both groups were perfectly matched. Follow-up was 100%. Long term survival, median 4.2 years, was comparable in both groups (log-rank test: chi2 0.30; df = 1; P = 0.58), indicating no influence on survival from performing either a concomitant or staged procedure. No relation could be demonstrated between survival and age, histopathology or extent of tumour; nor in the concomitantly operated group between survival and timing of lung resection in relation to extra-corporeal circulation. Overall peri-operative mortality was 6/34, 17.6%, but a large difference was noted between the two groups (5/24, 20.8% vs. 1/10, 10%; P = 0.64), underscoring the greater risk involved in the concomitant procedure, although this difference was not statistically significant because of small numbers.
Conclusions:
No difference in survival between the two groups, one operated upon in a staged procedure, the other concomitantly, could be demonstrated. However, the greater perioperative risk makes the concomitant procedure less attractive, and the staged approach the preferred one. Interval between operations can be individualized according to the clinical status of the particular patient to a period as short as 2 weeks.