Management and postoperative outcome in primary lung cancer and heart disease co-morbidity: a systematic review and meta-analysis

Abstract

Background: Co-morbidity of primary lung cancer (LC) and heart disease (HD), both requiring surgical therapy, characterizes a high risk group of patients necessitating prompt diagnosis and treatment. The aim of this study is the review of available evidence guiding the management of these patients.

Methods: Postoperative outcome of patients operated for primary LC (first meta-analysis) and for both primary LC and HD co-morbidity (second meta-analysis), were studied. Parameters examined in both meta-analyses were thirty-day postoperative mortality, postoperative complications, three- and five-year survival probabilities. The last 36 years were reviewed by using the PubMed data base. Thirty-seven studies were qualified for both meta-analyses.

Results: The pooled 30-day mortality percentages (%) were 4.16% [95% confidence interval (CI): 2.68-5.95] (first meta-analysis) and 5.26% (95% CI: 3.47-7.62) (second meta-analysis). Higher percentages of squamous histology and lobectomy, were significantly associated with increased (P=0.001) and decreased (P<0.001) thirty-day postoperative mortality, respectively (first meta-analysis). The pooled percentages for postoperative complications were 34.32% (95% CI: 24.59-44.75) (first meta-analysis) and 45.59% (95% CI: 35.62-55.74) (second meta-analysis). Higher percentages of squamous histology (P=0.001), lobectomy (P=0.002) and p-T1 or p-T2 (P=0.034) were associated with higher proportions of postoperative complications (second meta-analysis). The pooled three- and five- year survival probabilities were 68.25% (95% CI: 45.93-86.86) and 52.03% (95% CI: 34.71-69.11), respectively. Higher mean age (P=0.046) and percentage lobectomy (P=0.009) significantly reduced the five-year survival probability.

Conclusions: Lobectomy and age were both accompanied by reduced five-year survival rate. Also, combined aorto-coronary bypass grafting (CABG) with lobectomy for squamous pT1 or pT2 LC displayed a higher risk of postoperative complications. Moreover, medical decision between combined or staged surgery is suggested to be individualized based on adequacy of coronary arterial perfusion, age, patient's preoperative performance status (taking into account possible co-morbidities per patient), tumor's staging and extent of lung resection.

Keywords: Lung neoplasms; heart disease (HD); intra-operative complications; perioperative period; surgery; survival rate.

Figure 1

Flow diagram of the articles selected for both meta-analyses.

Figure 2

Forest plots of (A) 30-day postoperative mortality and (B) postoperative complications from studies concerning the impact of perioperative management on postoperative outcome of patients operated for primary lung cancer (first meta-analysis).

Figure 3

Forest plots of (A) 30-day postoperative mortality and (B) postoperative complications by type of operation, from studies concerning the impact of combined or staged surgical procedures on postoperative outcome of patients operated for both primary lung cancer and heart disease co-morbidity (second meta-analysis).

Figure 4

Forest plots of (A) 3-year survival and (B) 5-year survival probability, from studies concerning the impact of combined or staged surgical procedures on postoperative outcome of patients operated for both primary lung cancer and heart disease co-morbidity (second meta-analysis).