Cardiac surgery in patients with lung tumor: local experience of Krasnodar Krai

Aim. To compare the immediate and long-term outcomes of surgical treatment of patients with lung tumor and concomitant coronary artery disease (CAD) requiring myocardial revascularization with revascularized patients without a lung tumor.

 Material and methods. The work included data on examination, treatment and follow-up of 30345 patients who underwent elective surgery at the Research Institute — Ochapovsky Regional Clinical Hospital № 1 in the period from January 1, 2015 to June 1, 2024. In total, 21909 patients were diagnosed with stable CAD aged 28 to 90 years (mean age, 64,1±12,4 years) and 9426 underwent myocardial revascularization by coronary artery bypass grafting (CABG). Two following groups of patients were formed: Group A — patients with CAD and a lung tumor verified by chest computed tomography, who underwent combined surgery of CABG and lung resection (n=71); Group B — patients with CAD without a lung tumor, who underwent isolated CABG, selected using a random number generator due to the large number of the original cohort (n=154).

Results. Patients from group A had more frequent inhospital complications (acute heart failure 6,86% vs 2,6%, p=0,02; arrhythmias such as atrial fibrillation 15,49% vs 4,55%, p=0,005; pneumonia 16,9% vs 4,55%, p=0,002; shunt thrombosis 2,82% vs 0%, p=0,04; sepsis 8,45% vs 1,3%, p=0,007), which naturally led to an increase in hospital stay length (15,06±8,69 vs 9,36±8,26 days, p<0,001). In group A, 2 patients died during hospitalization due to shunt thrombosis, and in group B no patients died. However, this indicator did not reach statistical significance (p=0,06). In the long-term follow-up period (6 months — 6 years), high mortality was found in patients from group A due to cancer progression, while cardiovascular mortality and ischemic events were comparable in both groups. In addition, the prognosis of patients depended on tumor histology and, predictably, the best long-term survival was in patients with benign lung neoplasms, as well as with lung adenocarcinoma.

Conclusion. Our results have important implications for the practicing surgeon, as they will improve his decision-making process about the revascularization type. However, further studies are needed on the factors underlying the decision to perform CABG in cancer patients, the impact of patient and physician perception of cancer prognosis, and factors associated with survival after CABG among cancer patients.

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