Abstract
Background Locally advanced (T4) non-small cell lung cancer (NSCLC) is principally amenable
to surgery. For radical resection of cardiovascular structures, extracorporeal circulation
(ECC) may be required. Tumor dissemination is a concern in this situation. In this
study, we evaluate the long-term results of T4 NSCLC surgery with ECC and compare
them with combined cardiopulmonary surgery for early-stage NSCLC and heart disease.
Methods We retrospectively analyzed 16 patients undergoing surgery on ECC over a 13-year
period. Eight patients suffered from T4 NSCLC (group A), and another eight patients
suffered from coincidental T1–T2 NSCLC and heart disease (group B).
Results In group A, five patients received neoadjuvant radiochemotherapy. Complete resection
was achieved in all patients. Thirty-day mortality was one patient (12.5%) in each
group. Six patients died from recurrent cancer with a median survival of 13.6 months
in group A. Prognosis in patients with direct tumor invasion of the aortopulmonary
window was a lot worse compared to those with atrial infiltration. One T4 patient
who had only received surgery survived for 155 months without relapse. In group B,
no NSCLC relapse occurred, and median survival was 21.6 months. All but one death
in group B occurred due to cardiovascular incidents.
Conclusions Surgery on ECC for T4 NSCLC gives satisfactory results. The site of infiltration
appears to be most important for local tumor relapse. Long-term survival is possible
in some cases. Simultaneous cardiac and pulmonary surgery resulted in good early and
midterm outcomes without surgery-induced tumor propagation.
Keywords
lung cancer - NSCLC - cardiopulmonary surgery - extracorporeal circulation - cardiopulmonary
bypass ECC
