Tourmousoglou Christos E, Apostolakis Efstratios, Dougenis Dimitrios
Department of Cardiothoracic Surgery, University Hospital of Patra, Patra, Greece
Department of Cardiothoracic Surgery, University Hospital of Ioannina, Ioannina, Greece.
Interact Cardiovasc Thorac Surg. 2014 Oct;19(4):673-81. doi: 10.1093/icvts/ivu218. Epub 2014 Jul 6.
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether combined surgical procedures in one or two stages are the best surgical treatment strategy in patients with simultaneous coronary artery disease and lung cancer. Altogether, 264 papers were found using the reported search; of which, 15 represented the best evidence to answer the clinical question. The authors, journal, date, country of publication, patient group, study type, outcomes and results of papers are tabulated. The outcomes of the reported studies provided interesting results. All the studies were retrospective. Ten papers reported the results of combined and staged operations. The operative mortality rate of combined procedures was 0-20.8% and of staged procedures was 0-10%. The reoperation rate for bleeding of combined procedures was 0-11% and of staged procedures was 0%. The survival rate of combined procedures at 1 year was 79-100%, at 5 years was 34.9-85% and at 7 years was 61%. The survival rate of staged procedures at 1 year was 72.7% and at 5 years was 53%. Five studies reported the results of off-pump coronary artery bypass grafting (OPCABG) and lung surgery versus on-pump and lung surgery. The operative mortality rate of OPCABG and lung surgery was 0-6.6%. The 2-year survival rate of OPCABG and lung surgery was 47% and the 5-year survival rate was 13-68%. The re-exploration rate for bleeding of OPCABG was 4%. Simultaneous lung surgery and CABG could be safely performed with adequate cancer-free survival in patients with Stage I or II lung cancer. Lung surgery is better performed before institution of cardiopulmonary bypass, avoiding the complications of such a technique. Long-term survival after combined treatment is mostly related to the predicted survival after lung resection. This depends on the T stage and mostly on the patient's nodal status. In certain high-risk groups (if the cardiac procedure is difficult or if the patient is unstable), separate staged procedures (CABG as the first and lung resection as the second procedure) might be the most prudent action (3-6 weeks apart). There is also another option: OPCABG and lung resection, which could be a safe and effective treatment when unstable coronary heart disease and lung cancer coexist.
一篇心脏外科的最佳证据主题文章是按照结构化方案撰写的。所探讨的问题是，对于同时患有冠状动脉疾病和肺癌的患者，一期或二期联合手术是否是最佳的手术治疗策略。通过报告的检索共找到264篇论文；其中15篇代表了回答该临床问题的最佳证据。现将论文的作者、期刊、日期、发表国家、患者群体、研究类型、结果及成果制成表格。所报告研究的结果提供了有趣的发现。所有研究均为回顾性研究。10篇论文报告了联合手术和分期手术的结果。联合手术的手术死亡率为0 - 20.8%，分期手术的手术死亡率为0 - 10%。联合手术的出血再手术率为0 - 11%，分期手术的出血再手术率为0%。联合手术1年生存率为79 - 100%，5年生存率为34.9 - 85%，7年生存率为61%。分期手术1年生存率为72.7%，5年生存率为53%。5项研究报告了非体外循环冠状动脉搭桥术（OPCABG）联合肺手术与体外循环联合肺手术的结果。OPCABG联合肺手术的手术死亡率为0 - 6.6%。OPCABG联合肺手术的2年生存率为47%，5年生存率为13 - 68%。OPCABG的出血再次探查率为4%。对于I期或II期肺癌患者，同期肺手术和冠状动脉搭桥术可安全实施，并能获得足够的无癌生存期。肺手术最好在建立体外循环之前进行，以避免该技术的并发症。联合治疗后的长期生存大多与肺切除术后的预期生存有关。这取决于T分期，主要取决于患者的淋巴结状态。在某些高危组（如果心脏手术困难或患者不稳定），分期手术（先进行冠状动脉搭桥术，3 - 6周后再进行肺切除术）可能是最谨慎的做法。还有另一种选择：OPCABG联合肺切除术，当不稳定型冠心病和肺癌并存时，这可能是一种安全有效的治疗方法。
