Lung Cancer Surgery in Patients With a History of Coronary Artery Bypass Graft: A Multicentre Study

Clinical Efficacy of Single-Port Thoracoscopic Lobectomy versus Three-Port Thoracoscopic Lobectomy for Lung Cancer

Objective

To evaluate the clinical efficacy of single-port thoracoscopic lobectomy versus three-port thoracoscopic lobectomy for lung cancer.

Methods

From February 2020 to February 2021, 200 lung cancer patients treated in our institution assessed for eligibility were enrolled and randomly assigned (1 : 1) to either the experimental group (single-port thoracoscopic lobectomy) or the control group (three-port thoracoscopic lobectomy). The outcomes were the eligible patients' surgical indices, pain stress indexes, and postoperative complications.

Results

The experimental group outperformed the control group in terms of incision length, postoperative drainage time, extubation time, time to get out of bed, time to analgesics administration, and postoperative pain score (P < 0.001). Compared with the control group, the experimental group reduced the intraoperative bleeding (161.98 ± 10.65 versus 179.65 ± 14.20, P < 0.001) and length of hospital stay (7.98 ± 0.56 versus 10.46 ± 1.23, P < 0.001). The operative time of the single-port thoracoscopic lobectomy was longer than that of the three-port thoracoscopic lobectomy (P < 0.001). There was no statistical difference between the two groups in the intraoperative conversion to thoracotomy and the number of lymph node dissections (P > 0.05). Postoperative pain stress indices and complication rates of the experimental group were significantly lower than those of the control group (P < 0.001).

Conclusion

Single-port thoracoscopic lobectomy can improve the perioperative indices of lung cancer patients, reduce their pain stress response, and accelerate postoperative recovery. However, its operation is difficult and time-consuming, requiring experienced surgeons for improved surgical outcomes in practice.

Coronary revascularisation outcomes in patients with cancer

Cancer and coronary artery disease (CAD) overlap in traditional risk factors as well as molecular mechanisms underpinning the development of these two disease states. Patients with cancer are at increased risk of developing CAD, representing a high-risk population that are increasingly undergoing coronary revascularisation. Over 1 in 10 patients with CAD that require revascularisation with either percutaneous coronary intervention or coronary artery bypass grafting have either a history of cancer or active cancer. These patients are typically older, have more comorbidities and have more extensive CAD compared with patients without cancer. Haematological abnormalities with competing risks of thrombosis and bleeding pose further unique challenges during and after revascularisation. Management of patients with concurrent cancer and CAD requiring revascularisation is challenging as these patients carry a higher risk of morbidity and mortality compared with those without cancer, often driven by the underlying cancer and associated comorbidities. However, due to variability by different types and stages of cancer, revascularisation outcomes are specific to cancer characteristics such as the timing of onset, cancer subtype and site, stage, presence of metastases, and cancer-related therapies received. Recent studies have provided insights into defining revascularisation outcomes, procedural considerations and best practices in managing patients with cancer. Nevertheless, many gaps remain that require further studies to inform clinical best practices in this population.