Parshin V D, Belov Yu V, Chernyavsky S A, Komarov R N, Parshin A V, Parshin V V, Ursov M A
Sechenov First Moscow State Medical University, Moscow, Russia.
National Medical Research Center of Phthisiopulmonology and Infectious Diseases, Moscow, Russia.
Khirurgiia (Mosk). 2023(8):20-30. doi: 10.17116/hirurgia202308120.
To analyse safety and expediency of cardiac surgical technologies including cardiopulmonary bypass (CPB) in patients with locally advanced lung cancer and invasive tumors of the mediastinum.
Cardiac surgical techniques and CPB were used in 23 patients (group 1) with locally advanced thoracic tumors between 2005 and 2015. For the same period, there were 22 patients (group 2) who underwent combined surgeries and could have had similar techniques. However, these techniques were not used for various reasons. Mediastinal malignancies and non-small cell lung cancer were diagnosed in 26 (57.8%) and 19 (42.2%) patients, respectively. Invasion of superior vena cava (=15), aorta (=13) and pulmonary artery (=12) was the most common. Lesion of innominate vein (=8), left atrium (=6) and innominate artery (=4) was less common. A total of 21 pneumonectomies were performed (14 in the first group and 7 in the second group). Lobectomy was less common (one patient in each group). Sublobar lung resection was performed in 10 patients (2 patients in the first group and 8 ones in the second group). All resections were total in the first group (R0) that was confirmed by routine morphological examination of resection margins of different organs and vessels. The situation was worse in the second group (R1 in 19 (86.4%) patients, R2 in 3 (13.6%) patients).
Total postoperative morbidity was 53.3%, mortality - 8.2%. These values are higher compared to patients undergoing surgical treatment for thoracic malignancies. Incidence of postoperative complications was higher in the first group (16 (69.6%) and 8 (36.4%), respectively). Four patients died in the first group. Sepsis (=2), acute right ventricular failure (=1) and acute myocardial infarction (=1) caused death. There were no lethal outcomes in the second group. Various postoperative complications were diagnosed only in 8 (36.4%) patients. The long-term results were followed-up in 80% of patients. In the first group, 3- and 5-year survival rates were 30.5% and 25%, respectively (median 43.8 months). In the second group, these values were 25% and 2%, respectively (median 24.9 months). Long-term mortality in the second group was caused by progression of malignant process, including local recurrence, after palliative surgery (R1, R2 resection).
Higher risk of postoperative complications and mortality in patients undergoing on-pump surgery is compensated by significantly better long-term results. Further progress is associated with higher safety of CPB, as well as solving some organizational and educational problems.
分析包括体外循环（CPB）在内的心脏外科技术在局部晚期肺癌和纵隔浸润性肿瘤患者中的安全性和可行性。
2005年至2015年间，对23例（第1组）局部晚期胸部肿瘤患者采用了心脏外科技术和CPB。同期，有22例（第2组）患者接受了联合手术，本可采用类似技术，但由于各种原因未使用。分别有26例（57.8%）和19例（42.2%）患者被诊断为纵隔恶性肿瘤和非小细胞肺癌。上腔静脉侵犯（=15例）、主动脉侵犯（=13例）和肺动脉侵犯（=12例）最为常见。无名静脉病变（=8例）、左心房病变（=6例）和无名动脉病变（=4例）较少见。共进行了21例全肺切除术（第1组14例，第2组7例）。肺叶切除术较少见（每组1例）。10例患者进行了肺叶以下肺切除术（第1组2例，第2组8例）。第1组所有切除均为根治性切除（R0），不同器官和血管切缘的常规形态学检查证实了这一点。第2组情况较差（19例（86.4%）患者为R1切除，3例（13.6%）患者为R2切除）。
术后总发病率为53.3%，死亡率为8.2%。与接受胸部恶性肿瘤手术治疗的患者相比，这些数值更高。第1组术后并发症发生率更高（分别为16例（69.6%）和8例（36.4%））。第1组有4例患者死亡。脓毒症（=2例）、急性右心衰竭（=1例）和急性心肌梗死（=1例）导致死亡。第2组无致死性结局。仅8例（36.4%）患者诊断出各种术后并发症。80%的患者进行了长期随访。第1组3年和5年生存率分别为30.5%和25%（中位生存期43.8个月）。第2组的这些数值分别为25%和2%（中位生存期24.9个月）。第2组的长期死亡率是由姑息性手术后（R1、R2切除）恶性病程进展所致，包括局部复发。
体外循环手术患者术后并发症和死亡率较高的风险被显著更好的长期结果所抵消。进一步的进展与CPB更高的安全性以及解决一些组织和教育问题相关。
