Abstract
We studied the perioperative management (PM) of patients with both lung cancer (LC) and cardiac disease (CD) comorbidity (LCC) and their comparative clinical outcome between combined (CP) and staged (SP) surgical procedure. We searched international literature between 1990 up end of 2014, examining two different kinds of meta-analyses concerning a) the perioperative management (PM) and b) the clinical outcome (CO) of CP compared to SP inthe surgical management of these patients. For mortality rates and sequellae we used Freeman-Tukey transformation while for investigation of interpretation factors we used "Stat" meta-regression package, All studies agree that PM of patients with LCC includes sufficient myocardial perfusion prior to other surgery and the importance of pre/post-operative management. CO is affected is influenced by the surgical incision, the extracorporel circulation and the type of vascular grafts used. LC of stage I or II is an indication for CP. Advanced heart failure, hemorragic predisposition, proximity of tumor to esophagus, descending aorta and infiltration of parietal or diaphragmatic pleura by the tumor are strong contraindications for CP. It is concluded that patients submitted to CP (cardiopulmonary bye-pass + squamous carcinoma stage pT1 or pT2 and lobectomy) exhibit increased risk for postoperative complication not amenable to the cardiopulmonary bye-pass or the type of operation.
- Copyright ©ERS 2015