Voets A J, Joesoef K S, van Teeffelen M E
Department of Pulmonology, Thoraxcentrum, Medisch Centrum de Klokkenberg, Breda, The Netherlands.
Eur J Cardiothorac Surg. 1997 Nov;12(5):713-7. doi: 10.1016/s1010-7940(97)00240-6.
The assessment of the best surgical approach in patients with synchroneously occurring lung cancer (stages I and II) and coronary artery disease: concomitant or staged.
A retrospective, observational study was conducted in a tertiary centre for cardiothoracic surgery. From 1988-1995, 34 patients underwent pulmonary resection for stages I-II primary bronchogenic carcinoma and open-heart surgery (almost always coronary-artery bypass grafting), either concomitantly (n = 24) or in a staged procedure (n = 10). Mean interval between operations was 33.9 +/- 34.7 days (range: 12-120 days). Results were statistically computed.
Preoperatively both groups were perfectly matched. Follow-up was 100%. Long term survival, median 4.2 years, was comparable in both groups (log-rank test: chi2 0.30; df = 1; P = 0.58), indicating no influence on survival from performing either a concomitant or staged procedure. No relation could be demonstrated between survival and age, histopathology or extent of tumour; nor in the concomitantly operated group between survival and timing of lung resection in relation to extra-corporeal circulation. Overall peri-operative mortality was 6/34, 17.6%, but a large difference was noted between the two groups (5/24, 20.8% vs. 1/10, 10%; P = 0.64), underscoring the greater risk involved in the concomitant procedure, although this difference was not statistically significant because of small numbers.
No difference in survival between the two groups, one operated upon in a staged procedure, the other concomitantly, could be demonstrated. However, the greater perioperative risk makes the concomitant procedure less attractive, and the staged approach the preferred one. Interval between operations can be individualized according to the clinical status of the particular patient to a period as short as 2 weeks.
评估同步发生的肺癌（Ⅰ期和Ⅱ期）合并冠状动脉疾病患者的最佳手术方式：同期手术或分期手术。
在一家三级心胸外科中心进行了一项回顾性观察研究。1988年至1995年期间，34例患者接受了Ⅰ - Ⅱ期原发性支气管肺癌的肺切除术和心脏直视手术（几乎均为冠状动脉旁路移植术），其中同期手术24例，分期手术10例。手术间隔时间平均为33.9±34.7天（范围：12 - 120天）。对结果进行了统计学计算。
术前两组患者完全匹配。随访率为100%。两组的长期生存率（中位数4.2年）相当（对数秩检验：χ²0.30；自由度 = 1；P = 0.58），表明同期手术或分期手术对生存率均无影响。未发现生存率与年龄、组织病理学或肿瘤范围之间存在关联；在同期手术组中，也未发现肺切除术时间与体外循环相关的生存率之间存在关联。围手术期总死亡率为6/34，即17.6%，但两组之间存在较大差异（5/24，20.8%对1/10，10%；P = 0.64），这突出了同期手术的更高风险，尽管由于样本量小，这种差异无统计学意义。
两组患者的生存率无差异，一组采用分期手术，另一组采用同期手术。然而，同期手术围手术期风险更高，使其吸引力降低，分期手术为首选方式。手术间隔时间可根据特定患者的临床状况个体化，最短可为2周。
