Combined operation for lung cancer and cardiac disease

From 1965 through 1992. 30 patients (23 men and 7 women) underwent pulmonary resection for primary lung cancer and a concomitant open heart operation (combined group). Median age was 68 years (range, 50 to 79 years). Coronary artery bypass was performed in 23 patients, mitral valve repair in 2, mitral valve replacement in 2, and other procedures in 3. Pulmonary resections included pneumonectomy in 1 patient bilobectomy in 1, lobectomy in 21, and wedge excision in 7. Twentythree patients were in postsurgical stage I. There were two operative deaths (6.7%), one from myocardial ischemia and one from pulmonary insufficiency. Overall 5-year survival was 34.9% and was not affected by the stage of the disease. During the same period, 15 other patients underwent an open heart operation (coronary artery bypass in 11, aortic valve replacement in 2, and other in 2) followed by pulmonary resection (pneumonectomy in 5, lobectomy in 9, and wedge excision in 1) for lung cancer 1 to 11 months later (median, 2 months) (staged group). There were no operative deaths. Six patients were in postoperative stage I. Overall 5-year survival was 53.0% (p = not significant), but it was significantly affected by the stage of lung cancer. Most important, a significant difference was observed in stage I survival between the two groups. Five-year survival for stage I patients in the staged group was 100.0%, compared with only 36.5% for the combined stage I patients (p < 0.05). We conclude that although pulmonary resection for lung cancer in patients undergoing concomitant open heart operation can be performed safely with low morbidity and mortality, long-term survival may be compromised. Candidates for the combined procedures should be limited to patients who cannot tolerate a second procedure.