Kalp Cerrahisi ve Akciğer Kanseri Eş Zamanlı Opere Edilmeli mi?

Yıl 2019, Cilt: 22 Sayı: 3, 152 - 156, 24.12.2019

Murat Akkuş

Öz

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.

Anahtar Kelimeler

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

Should Cardiac Surgery and Lung Cancer Be Operated Simultaneously?

Öz

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.

Anahtar Kelimeler

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

Kaynakça

• 1. Ma X, Huang F, Zhang Z, Song F, Ou S. Lung cancer resection with concurrent off-pump coronary artery bypasses: safety and efficiency. J Thorac Dis 2016;8:2038.
• 2. Dalton JM, Parker TM, Mistrot JJ, Bricker DL. Concomitant coronary artery bypass and major noncardiac surgery. J Thorac Cardiovasc Surg 1978;75:621-4.
• 3. Girardet RE, Masri ZH, Lansing AM. Pulmonary lesions in patients undergoing open heart surgery: approach and management. J Ky Med Assoc 1981;79:645-8.
• 4. Dyszkiewicz W, Jemielity MM, Piwkowski CT, Perek B, Kasprzyk M. Simultaneous lung resection for cancer and myocardial revascularization without cardiopulmonary bypass (off-pump coronary artery bypass grafting). Ann Thorac Surg 2004;77:1023-7.
• 5. de la Rivière Brutel A, Knaepen P, Van HS, Vanderschueren R, Ernst J, den Bosch Van J. Concomitant open heart surgery and pulmonary resection for lung cancer. Eur J Cardiothorac Surg 1995;9:310-3;discussion 313-4.
• 6. Ginsberg RJ, Rubinstein LV, Lung Cancer Study Group. Randomized trial of lobectomy versus limited resection for T1 N0 non-small cell lung cancer. Ann Thorac Surg 1995;60:615-23.
• 7. Rao V, Todd TR, Weisel RD, Komeda M, Cohen G, Ikonomidis JS, et al. Results of combined pulmonary resection and cardiac operation. Ann Thorac Surg 1996;62:342-7.
• 8. Cooper JD, Nelems JM, Pearson FG. Extended indications for median sternotomy in patients requiring pulmonary resection. Ann Thorac Surg 1978;26:413-20.
• 9. Meng RL, Jensik RJ, Kittle CF, Faber LP. Median sternotomy for synchronous bilateral pulmonary operations. J Thorac Cardiovasc Surg 1980;80:1-7.
• 10. Harker LA. Bleeding after cardiopulmonary bypass. N Engl J Med 1986;314:1446-7.
• 11. Ulicny KS Jr, Schmelzer V, Flege JB Jr, Todd JC, Mitts DL, Melvin DB, et al. Concomitant cardiac and pulmonary operation: the role of cardiopulmonary bypass. Ann Thorac Surg 1992;54:289-95.
• 12. Partrick DA, Moore EE, Fullerton DA, Barnett CC Jr, Meldrum DR, Silliman CC. Cardiopulmonary bypass renders patients at risk for multiple organ failure via early neutrophil priming and late neutrophil disability. J Surg Res 1999;86:42-9.
• 13. Kauffmann M, Krüger T, Aebert H. Surgery on extracorporeal circulation in early and advanced non-small cell lung cancer. Thorac Cardiovasc Surg 2013;61:103-8.
• 14. Carrascal Y, Gualis J, Arévalo A, Fulquet E, Flórez S, Rey J, et al. Cardiac surgery with extracorporeal circulation in cancer patients: influence on surgical morbidity and mortality, and on survival. Rev Esp Cardiol 2008;61:369-75.
• 15. Suzuki S, Usui A, Yoshida K, Matsuura A, Ichihara T, Ueda Y. Effect of cardiopulmonary bypass on cancer prognosis. Asian Cardiovasc Thorac Ann 2010;18:536-40.
• 16. Okay T. Eş zamanlı akciğer kanseri ve kalp hastalığı. Toraks Cerrahisi Bülteni 2015;9:269-82.
• 17. Schoenmakers MC, van Boven WJ, van den Bosch J, van Swieten HA. Comparison of on-pump or off-pump coronary artery revascularization with lung resection. Ann Thorac Surg 2007;84:504-9.
• 18. Cathenis KO, Hamerlijnck R, Vermassen F, Van Nooten G, Muysoms F. Concomitant cardiac surgery and pulmonary resection. Acta Chirurgica Belgica 2009;109:306-11.
• 19. Johnson JA, Landreneau RJ, Boley TM, Haggerty SP, Hattler B, Curtis JJ, et al. Should pulmonary lesions be resected at the time of open heart surgery? Am Surg 1996;62:300-3.
• 20. Ciriaco P, Carretta A, Calori G, Mazzone P, Zannini P. Lung resection for cancer in patients with coronary arterial disease: analysis of short-term results. Eur J Cardiothorac Surg 2002;22:35-40.
• 21. Yokoyama T, Derrick MJ, Lee AW. Cardiac operation with associated pulmonary resection. J Thorac Cardiovasc Surg 1993;105:912-6.
• 22. Miller DL, Orszulak TA, Pairolero PC, Trastek VF, Schaff HV. Combined operation for lung cancer and cardiac disease. Ann Thorac Surg 1994;58:989-94.
• 23. Tourmousoglou CE, Apostolakis E, Dougenis D. Simultaneous occurrence of coronary artery disease and lung cancer: what is the best surgical treatment strategy? Int Cardiovasc Thorac Surg 2014;19:673-81.
• 24. Danton MH, Anikin VA, McManus KG, McGuigan JA, Campalani G. Simultaneous cardiac surgery with pulmonary resection: presentation of series and review of literature. Eur J Cardiothorac Surg 1998;13:667-72.