Lung resection for cancer in patients with coronary arterial disease: analysis of short-term results

Objective: Patients with lung cancer may present concomitant coronary arterial disease. Feasibility of lung resection is dependent on the severity of the cardiac impairment since it can increase operative morbidity and mortality. The aim of this study was to analyze the results of lung resection in patients with coronary arterial disease in terms of operative complications and hospital stay. Methods: Between January 1993 and March 2001, 50 patients with coronary arterial disease underwent lung resection for cancer at our department. Nineteen patients with a curable left-main or multiple-vessel disease first underwent surgical (six patients) or transluminal (13 patients) myocardial revascularization. Twenty-two of the 31 patients who did not require myocardial revascularization presented a medium-high cardiac risk. Univariate analysis determined the impact of coronary disease on operative complications and hospital stay. Results: Surgery consisted in 40 lobectomies, three pneumonectomics and seven wedge resections. The overall mortality and morbidity rates were 4% and 28%, respectively. Ten patients (22%) experienced postoperative cardiac complications such as arrhythmia and there was one intraoperative death, three suffered secretion retention and one patient died as a consequence of a stroke. Occurrence of postoperative complications was influenced by age (P = 0.02) and the presence of medium-high cardiac risk (P = 0.03). Hospital stay was longer for patients who did not have prior myocardial revascularization (11.7 +/- 4 vs. 8.1 +/- 3 days) and underwent more extensive pulmonary resection (10.6 +/- 5 vs. 7.4 +/- 2 days). Conclusions: Lung resection in patients with coronary arterial disease is justified in selected cases. Previous myocardial revascularization and limited resections can decrease operative complications and hospital stay. Careful preoperative evaluation can identify patients who might benefit from myocardial revascularization prior to surgery. (C) 2002 Elsevier Science B.V. All rights reserved.