Staged management of cardiac disease and concomitant early lung cancer: a 20-year single-center experience.

Autor:	Tricard J; Division of Thoracic Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City, Canada.; Cardiac Surgery Department, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City, Canada.; Thoracic and Cardiovascular Surgery Department, Limoges University Hospital Center, Limoges, France., Milad D; Division of Thoracic Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City, Canada., Chermat A; Thoracic and Cardiovascular Surgery Department, Limoges University Hospital Center, Limoges, France., Simard S; Division of Thoracic Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City, Canada.; Cardiac Surgery Department, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City, Canada., Lacasse Y; Division of Thoracic Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City, Canada., Dagenais F; Cardiac Surgery Department, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City, Canada., Conti M; Division of Thoracic Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City, Canada.
Jazyk:	angličtina
Zdroj:	European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery [Eur J Cardiothorac Surg] 2021 Apr 13; Vol. 59 (3), pp. 610-616.
DOI:	10.1093/ejcts/ezaa360
Abstrakt:	Objectives: The association of unstable heart disease and resectable lung cancer is rare. The impacts of staged management, cardiac surgery with cardiopulmonary bypass (CPB) versus angioplasty, on long-term survival and cancer recurrence remain debated. We report our experience using staged management. Methods: From 1997 to 2016, 107 patients were treated at the Quebec Heart and Lung Institute: 72 underwent cardiac surgery with CPB (group 1), 35 were treated with angioplasty (group 2), followed by oncological pulmonary resection. Results: Two postoperative deaths (3%) and 1 ischaemic heart complication (1%) were reported in group 1. One death (3%) was reported in group 2. Two-year overall survival was 82% (59/72) in group 1 and 80% (28/35) in group 2; 5-year overall survival was 62% (33/53) in group 1 and 63% (19/30) in group 2. Two-year disease-free survival in group 1 was 79% (57/72) and 77% (27/35) in group 2; 5-year disease-free survival was 58% (31/53) in group 1 and 60% (18/30) in group 2. The independent risk factors for death after thoracic surgery were transfusions (P = 0.004) and grade ≥3 complications (P = 0.034). Independent risk factors for recurrence included the cancer stage (P < 0.001) and, paradoxically, a shorter delay between cardiac and lung procedures (P = 0.031). Conclusions: When a staged management remains feasible after cardiac procedure, oncological outcomes of patients with cardiopathy and lung cancer are satisfactory. CPB does not seem to be deleterious. The delay between procedures should intuitively be as small as possible but not at the expense of good recovery after the cardiac procedure. (© The Author(s) 2020. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)
Databáze:	MEDLINE
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