Kalp Cerrahisi ve Akciğer Kanseri Eş Zamanlı Opere Edilmeli mi?

Year 2019, Volume: 22 Issue: 3, 152 - 156, 24.12.2019

Murat Akkuş

Abstract

Giriş: Rezektabl akciğer kanseri (LC) ve kardiyak cerrahi (CS) birlikte uygulanmasının cerrahi sonuçları açısından sınırlı sayıda çalışma mevcuttur. Bu çalışmada eş zamanlı LC nedeniyle majör akciğer rezeksiyonu ve CS uygulanan olgularımızın sonuçlarını literatür eşliğinde sunmayı amaçladık.

Hastalar ve Yöntem: Ekim 2011-Mayıs 2019 tarihleri arasında eş zamanlı CS ile opere edilen 10 (sekiz erkek, iki kadın) akciğer kanseri olgusu çalışmaya alındı. Olguların median yaşı 67 (43-78) yıl idi. Tüm olgularda sternotomi uygulandı, bir sol alt lob tümörüne sternotomi sonrası sol torakotomi eklendi. Yedi olgu koroner arter cerrahisi, bir olgu aort darlığı, bir olgu mitral darlığı ve bir olgu intraatriyal kitle nedeniyle kalp operasyonuna alındı.

Bulgular: Erken dönem mortalite izlenmedi. Postoperatif kanamaya bağlı reoperasyona rastlanmadı. En sık komplikasyon atriyal fibrilasyon ile üç olguda izlendi. Dokuz olguya lobektomi, bir olguya bilobektomi uygulandı. Dört olguda adenokarsinom, iki olguda skuamöz hücreli karsinom, bir olguda küçük hücreli karsinom, bir olguda büyük hücreli karsinom, bir olguda indiferansiye yuvarlak hücreli karsinom ve bir olguda atipik karsinoid saptandı. Median yatış süresi 5.5 gün (4-10) idi. Median 74 ay (1-91) takip süresinde iki olgu nüks, bir olgu kardiyak arrest nedeniyle toplam 3 (%30) olgu da mortalite görüldü. Yedi olgu tümör saptanmamış olarak takip edilmektedir.

Sonuç: Sınırlı vaka sayısı ve literatürler eşliğinde incelendiğinde LC ve CS eş zamanlı cerrahi uygun, güvenilir ve tatmin edici sonuçları ile tercih edilebilir.

Keywords

Akciğer kanseri, kalp cerrahisi, kardiyopulmoner cerrahi, eş zamanlı kalp-akciğer operasyonu

Should Cardiac Surgery and Lung Cancer Be Operated Simultaneously?

Abstract

Introduction: There are limited studies regarding the concomitant surgical outcomes of resectable lung cancer (LC) and cardiac surgery (CS). This study aims to present the outcomes of cases with major pulmonary resection due to LC and CS that were operated upon simultaneously, and also present the literature associated with this procedure.

Patients and Methods: From October 2011 to May 2019, 10 LC patients (8 men, 2 women) who had undergone concomitant CSs were included in the study. The median age of the patients was 67 years (43-78). All patients underwent sternotomy, with left thoracotomy added after sternotomy for 1 left lower lobe tumour. Cardiac operations were performed for coronary artery problems in 7 cases, for aorta stenosis of 1 case, for mitral stenosis for 1 case and for an intra-atrial mass in 1 case.

Results: No mortality was observed in the early period. Re-operation linked to postoperative haemorrhage was not encountered. The most common complication was atrial fibrillation, which was seen in 3 cases. Nine cases underwent lobectomy, with 1 case undergoing bilobectomy. Four cases had adenocarcinoma, 2 cases had squamous cell carcinoma, 1 case had small cell carcinoma, 1 case had large cell carcinoma, 1 case had undifferentiated round cell carcinoma, and 1 case had atypical carcinoid tumour. The median duration of hospital stay was 5.5 days (4-10). Median follow-up was 74 months (1-91), with mortality observed in a total of 3 cases (30%); 2 due to recurrence and 1 due to cardiac arrest. Seven cases were tumour-free.

Conclusion: When limited cases studies and previous literature were investigated, the concomitant LC and CS method was observed to result in the highest number of appropriate, reliable and satisfactory outcomes.

Keywords

Lung cancer, cardiac surgery, cardiopulmonary surgery, concomitant heart lung operation

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