Surgical results of lung cancer treatment it patients with concomitant coronary artery disease

Background: Ischemic heart disease (IHD) occupies one of the leading positions among concomitant diseases in patients with lung cancer. However, to date, there are no uniform clinical recommendations for the treatment of cancer patients with concomitant coronary artery disease, requiring myocardial revascularization; the choice of surgical tactics remains a matter of debate; the immediate and long-term results of treatment of this group of patients have not been conclusively studied.

Objective: to study the short-term and long-term results of surgical treatment of patients with lung cancer with concomitant coronary artery disease, requiring myocardial revascularization.

Materials and methods: the study included 65 patients with lung cancer with concomitant coronary artery disease, operated on from 2001 to 2022 inclusive. Of these, 62 (95%) were men and 3 women, the average age was 64,7 years (51 to 80 years). The prevalence of the tumor process corresponded to stage I in 25 (38,5%), II – in 17 (26,5%) and III – in 23 
(35%) patients. The morphological variant of lung cancer was more often represented by adenocarcinoma and squamous cell carcinoma – 33 (50,7%) and 27 (41,6%), respectively, in 4 patients (6,2%) NETs (Neuroendocrine tumors) and in one patient undifferentiated lung cancer were detected. Concomitant coronary artery disease in most patients was characterized as painless myocardial ischemia – 33,8%, angina pectoris of small loads – 35,4% or unstable angina – 12,3% of observations. According to the results of coronary angiography, 37% (24/65) of patients had severe coronary lesions on the SYNTAX Score scale (SS>33 points). Myocardial revascularization by coronary artery bypass grafting was performed in 31 observations (47,7%), coronary angioplasty – in 34 patients (52,3%). For lung cancer, lobectomy /bilobectomy was performed in 78,5% of patients (51/65), pneumonectomy in 21,5% (14/65) of patients. Simultaneous operations were performed in 7,7% (5/65) of patients. With a phased tactic, the average interval between operations was 78,2 days.

Results: the incidence of postoperative complications was 33,8% (22/65), mortality – 3,1% (2/65); with phased tactics, these figures were 31,7% (19/60) and 3,3% (2/60); after simultaneous operations – 60% (3/5) and 0%, respectively. When performing operations for lung cancer after preliminary myocardial revascularization, the incidence of postoperative myocardial infarction was 3,3% (2/63), with a fatal outcome of 1,6% (1/63). In the long term, the total 1-, 3- and 5-year survival rate of radically operated patients was: at stage I – 95,7%, 86,3%, 64,7%, with II – 82,6%, 62,4%, 49,9% and at III – 66,0%, 55,8% and 34,3%, respectively (p = 0,042).

Conclusions: the implementation of prophylactic myocardial revascularization in patients with lung cancer with severe forms of concomitant coronary artery disease allows to expand the group of radically operated patients, to achieve satisfactory immediate and long-term treatment results.