冠状動脈再建術後の原発肺癌に対する肺切除症例の検討

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  • Evaluation of surgical management for lung cancer after coronary artery bypass grafting.

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Characteristics of surgical management for primary lung cancer after coronary artery bypass grafting (CABG) were evaluated in order to determine the propriety of pulmonary resection. Eight cases (7 men and 1 woman, mean age: 67 years) underwent pulmonary resection up to 54 months after CABG. Lung cancer was identified by an abnormal shadow in the chest X-ray in 6 patients, by examination before CABG in 1. and by the onset of pneumothorax in 1. Coronary arteriograms were made in 7 cases, but obstruction of the bypass graft was seen in only one case. Percutaneous transluminal coronary angioplasty (PTCA) was conducted in one case before pulmonary resection. Intra-aortic balloon pumping (IABP) was performed in one case with congestive heart failure. No severe perioperative or postoperative circulatory complications due to the lung cancer surgery was seen in any case. It is possible to conduct standard surgery, including lymph-node dissection, in lung cancer patients with CABG using PTCA or assisted IABP, providing that assessment of myocardial ischemia, the condition of the bypass graft, and changes in the coronary arteries and cardiac function are made prior to conducting the pulmonary resection procedure.

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