Feasibility of cardiac surgical techniques for intrathoracic tumors

Parshin V.D.; Belov Yu.V.; Chernyavsky S.V.; Komarov R.N.; Parshin A.V.; Parshin V.V.; Ursov M.A.

doi:https://doi.org/10.17116/hirurgia202308120

Parshin V.D.

Sechenov First Moscow State Medical University;
National Medical Research Center of Phthisiopulmonology and Infectious Diseases;
Federal Medical Biological Agency

ORCID: 0000-0002-0104-481X

Belov Yu.V.

Petrovsky National Research Center of Surgery;
Sechenov First Moscow State Medical University

SPIN RSCI: 2740-1439
Scopus AuthorID: 7101862336
ResearcherID: 7101862336
ORCID: 0000-0002-9280-8845

Chernyavsky S.V.

Sechenov First Moscow State Medical University

SPIN RSCI: 9479-9994
Scopus AuthorID: 57189703134
ORCID: 0000-0002-1564-9182

Komarov R.N.

Sechenov First Moscow State Medical University

ORCID: 0000-0002-3904-6415

Parshin A.V.

Sechenov First Moscow State Medical University

ORCID: 0000-0003-1804-3386

Parshin V.V.

Sechenov First Moscow State Medical University

ORCID: 0000-0002-6897-5715

Ursov M.A.

Sechenov First Moscow State Medical University

ORCID: 0000-0003-1501-6374

Feasibility of cardiac surgical techniques for intrathoracic tumors

Authors:

Parshin V.D., Belov Yu.V., Chernyavsky S.V., Komarov R.N., Parshin A.V., Parshin V.V., Ursov M.A.

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Journal: Pirogov Russian Journal of Surgery. 2023;(8): 20‑30

DOI: 10.17116/hirurgia202308120

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To cite this article:

Parshin VD, Belov YuV, Chernyavsky SV, Komarov RN, Parshin AV, Parshin VV, Ursov MA. Feasibility of cardiac surgical techniques for intrathoracic tumors. Pirogov Russian Journal of Surgery. 2023;(8):20‑30. (In Russ.)
https://doi.org/10.17116/hirurgia202308120

Подписка 2026 Хирургия. Журнал им. Н.И. Пирогова (Pirogov Russian Journal of Surgery)

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OBJECTIVE

To analyse safety and expediency of cardiac surgical technologies including cardiopulmonary bypass (CPB) in patients with locally advanced lung cancer and invasive tumors of the mediastinum.

MATERIAL AND METHODS

Cardiac surgical techniques and CPB were used in 23 patients (group 1) with locally advanced thoracic tumors between 2005 and 2015. For the same period, there were 22 patients (group 2) who underwent combined surgeries and could have had similar techniques. However, these techniques were not used for various reasons. Mediastinal malignancies and non-small cell lung cancer were diagnosed in 26 (57.8%) and 19 (42.2%) patients, respectively. Invasion of superior vena cava (n=15), aorta (n=13) and pulmonary artery (n=12) was the most common. Lesion of innominate vein (n=8), left atrium (n=6) and innominate artery (n=4) was less common. A total of 21 pneumonectomies were performed (14 in the first group and 7 in the second group). Lobectomy was less common (one patient in each group). Sublobar lung resection was performed in 10 patients (2 patients in the first group and 8 ones in the second group). All resections were total in the first group (R0) that was confirmed by routine morphological examination of resection margins of different organs and vessels. The situation was worse in the second group (R1 in 19 (86.4%) patients, R2 in 3 (13.6%) patients).

RESULTS

Total postoperative morbidity was 53.3%, mortality — 8.2%. These values are higher compared to patients undergoing surgical treatment for thoracic malignancies. Incidence of postoperative complications was higher in the first group (16 (69.6%) and 8 (36.4%), respectively). Four patients died in the first group. Sepsis (n=2), acute right ventricular failure (n=1) and acute myocardial infarction (n=1) caused death. There were no lethal outcomes in the second group. Various postoperative complications were diagnosed only in 8 (36.4%) patients. The long-term results were followed-up in 80% of patients. In the first group, 3- and 5-year survival rates were 30.5% and 25%, respectively (median 43.8 months). In the second group, these values were 25% and 2%, respectively (median 24.9 months). Long-term mortality in the second group was caused by progression of malignant process, including local recurrence, after palliative surgery (R1, R2 resection).

CONCLUSION

Higher risk of postoperative complications and mortality in patients undergoing on-pump surgery is compensated by significantly better long-term results. Further progress is associated with higher safety of CPB, as well as solving some organizational and educational problems.

Keywords:

mediastinal surgery

lung cancer

mediastinal tumour

cardiopulmonary bypass in oncology

treatment outcomes

combined cancer surgery

Authors:

Parshin V.D.

Sechenov First Moscow State Medical University;
National Medical Research Center of Phthisiopulmonology and Infectious Diseases;
Federal Medical Biological Agency

ORCID: 0000-0002-0104-481X

Belov Yu.V.

Petrovsky National Research Center of Surgery;
Sechenov First Moscow State Medical University

SPIN RSCI: 2740-1439
Scopus AuthorID: 7101862336
ResearcherID: 7101862336
ORCID: 0000-0002-9280-8845

Chernyavsky S.V.

Sechenov First Moscow State Medical University

SPIN RSCI: 9479-9994
Scopus AuthorID: 57189703134
ORCID: 0000-0002-1564-9182

Komarov R.N.

Sechenov First Moscow State Medical University

ORCID: 0000-0002-3904-6415

Parshin A.V.

Sechenov First Moscow State Medical University

ORCID: 0000-0003-1804-3386

Parshin V.V.

Sechenov First Moscow State Medical University

ORCID: 0000-0002-6897-5715

Ursov M.A.

Sechenov First Moscow State Medical University

ORCID: 0000-0003-1501-6374

Received:

10.01.2023

Accepted:

22.02.2023

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