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 Dec;12(6):898-902. doi: 10.1016/s1010-7940(97)00235-2.
The evaluation of the influence of open-heart surgery on the survival of patients with co-existent surgically amenable lung cancer stages I and II.
A retrospective, observational study was conducted in a tertiary centre for cardiothoracic surgery. From 1988 to 1995, 121 consecutive patients underwent pulmonary resection for stages I-II primary non-small cell bronchogenic carcinoma. Eighty seven of them had merely a lung carcinoma necessitating resection, 34 had in addition defined coronary-artery disease and consequently were also subjected to open-heart surgery. Results were statistically computed.
Follow-up was complete in 117/121 patients, 96.7% (83/87, 95.4% and 34/34, 100% in respective groups). Both groups were matched with regard to preoperative features possibly influencing survival. Median long term survival time was 4.3 years overall, 5.8 years for patients merely undergoing lung resection and 4.2 years for them undergoing open-heart surgery as well; this difference was not statistically significant (log-rank test: chi2 0.92, df= 1, P = 0.34), indicating no or limited influence of open-heart surgery on survival of patients with surgically amenable co-existent lung carcinoma. No relationship was found between survival and age, tumour stage, and histopathology. However, metastatic disease as cause of death was significantly increased in patients undergoing open-heart surgery (5/8 vs. 10/33, P = 0.0898), indicating a possible promotion of metastatic spread of co-existent lung carcinoma by this procedure. Overall perioperative mortality rate was 10/121, 8.3%, for the greater part the result of a relatively high mortality rate in the group of patients undergoing heart as well as lung surgery (6/34, 17.6%), underscoring the great risks involved in these patients, the mortality rate for lung resection alone being comparably low 4/87, 4.6% (P = 0.0191).
Open-heart surgery for defined coronary-artery disease in patients with surgically amenable lung carcinoma carries a substantially higher perioperative risk, but has no influence on long term results. Metastatic spread is possibly promoted by open-heart surgery. Optimal treatment, consisting of complete revascularization and appropriate lung resection, is therefore sufficiently justified by these results.
评估心脏直视手术对同时患有I期和II期可手术治疗肺癌患者生存率的影响。
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，121例连续患者因I-II期原发性非小细胞支气管肺癌接受了肺切除术。其中87例仅患有需要切除的肺癌，34例还患有明确的冠状动脉疾病，因此也接受了心脏直视手术。对结果进行了统计学计算。
121例患者中有117例完成了随访，随访率为96.7%（87例中的83例，95.4%；34例中的34例，100%）。两组在可能影响生存的术前特征方面进行了匹配。总体中位长期生存时间为4.3年，仅接受肺切除术的患者为5.8年，同时接受心脏直视手术的患者为4.2年；这种差异无统计学意义（对数秩检验：χ2 = 0.92，自由度= 1，P = 0.34），表明心脏直视手术对患有可手术治疗的并存肺癌患者的生存无影响或影响有限。未发现生存与年龄、肿瘤分期和组织病理学之间存在关联。然而，接受心脏直视手术的患者中因转移性疾病导致的死亡显著增加（8例中的5例与33例中的10例，P = 0.0898），表明该手术可能促进了并存肺癌的转移扩散。总体围手术期死亡率为121例中的10例，即8.3%，在很大程度上是由于接受心脏和肺部手术的患者组死亡率相对较高（34例中的6例，17.6%），这突出了这些患者所涉及的巨大风险，仅肺切除术的死亡率相对较低，为87例中的4例，即4.6%（P = 0.0191）。
对于患有可手术治疗肺癌的患者，因明确的冠状动脉疾病进行心脏直视手术的围手术期风险显著更高，但对长期结果无影响。心脏直视手术可能促进转移性扩散。因此，由完全血运重建和适当的肺切除术组成的最佳治疗方法，从这些结果来看是有充分理由的。
