Department of Cardiothoracic Surgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China.
Department of Radiology, The First Affiliated Hospital, Navy Medical University, Shanghai, People's Republic of China.
Thorac Cardiovasc Surg. 2024 Sep;72(6):435-440. doi: 10.1055/a-2184-6624. Epub 2023 Sep 29.
The best surgical treatment strategy for coexisting coronary artery disease (CAD) and lung cancer (LC) remains controversial. This study analyzed the safety and efficacy of a simultaneous minimally invasive procedure for patients with CAD and LC.
Patients who underwent simultaneous minimally invasive off-pump coronary artery bypass grafting and lung resection from January 2016 to December 2021 were retrospectively analyzed. The procedure was performed in the fourth intercostal space through a small left anterolateral minithoracotomy. Harvesting of the left internal mammary artery (LIMA) and sewing of the anastomoses were performed under direct vision. Lung resections were performed with or without the assistance of a thoracoscope.
Sixteen patients were included with a mean age of 67.13 ± 10.61 years. Procedural success occurred in all patients with a mean operative time of 366.88 ± 94.48 minutes. All patients received at least one coronary artery bypass LIMA graft. Pneumonectomy, lobectomy, segment resection, and wedge resection were performed in one (6.25%), eight (50%), two (12.5%), and five (31.25%) patients, respectively. There were no perioperative deaths or new myocardial infarctions. Complications included one case of postoperative bleeding, two lung infections, two cases of atelectasis, one case of pleural effusion, and one case of cardiac arrhythmia. All the patients were followed up for 1 to 57 months, cancer recurrence occurred in two patients, and one patient died. The remaining patients showed no evidence of tumor recurrence or myocardial infarction.
This simultaneous minimally invasive procedure is safe and effective for selected patients with CAD and LC.
同时患有冠状动脉疾病 (CAD) 和肺癌 (LC) 的患者的最佳手术治疗策略仍存在争议。本研究分析了同期微创治疗 CAD 合并 LC 患者的安全性和疗效。
回顾性分析了 2016 年 1 月至 2021 年 12 月同期行微创不停跳冠状动脉旁路移植术和肺切除术的患者。手术在第四肋间通过小左前外侧小开胸进行。直视下进行左内乳动脉（LIMA）的采集和吻合。肺切除术可在胸腔镜或非胸腔镜辅助下进行。
共纳入 16 例患者，平均年龄 67.13±10.61 岁。所有患者手术均成功，平均手术时间为 366.88±94.48 分钟。所有患者均至少接受一支冠状动脉旁路 LIMA 移植。1 例（6.25%）患者行全肺切除术，8 例（50%）患者行肺叶切除术，2 例（12.5%）患者行肺段切除术，5 例（31.25%）患者行楔形切除术。围手术期无死亡或新发心肌梗死。并发症包括 1 例术后出血、2 例肺部感染、2 例肺不张、1 例胸腔积液和 1 例心律失常。所有患者均随访 1~57 个月，2 例患者复发肿瘤，1 例患者死亡。其余患者均未出现肿瘤复发或心肌梗死的证据。
对于选择合适的 CAD 合并 LC 患者，同期微创治疗是安全有效的。
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