Perioperative safety of simultaneous pulmonary resection and off-pump coronary artery bypass grafting: a retrospective analysis from a single institution.

Background: As an increasing number of patients with both lung cancer and coronary artery disease (CAD) are being discovered, doctors face great challenges in treating this group. Off-pump coronary artery bypass grafting (CABG) combined with simultaneous radical surgery for lung cancer has become an option at some institutions. In this study, we aimed to explore postoperative complications, hospitalization duration and expenses, and surgical safety among patients who underwent simultaneous pulmonary resection and off-pump CABG, in order to provide a new treatment approach for lung cancer patients with coronary heart disease (CHD).

Methods: This study collected 85 patients who underwent lung resection and off-pump CABG at Tianjin Chest Hospital from 2020 to 2023. According to different methods of lung surgery, it is divided into two groups: lobectomy combined with off-pump CABG and wedge resection combined with off-pump CABG. These two groups were compared with 78 patients who only received off-pump CABG in terms of hospitalization time and cost, perioperative safety, and surgical complications, in order to evaluate the feasibility of lung resection combined with off-pump CABG.

Results: From the perspective of cardiac function, simultaneous pulmonary resection (lobectomy or wedge resection) and off-pump CABG did not affect postoperative cardiac function compared with off-pump CABG alone [left ventricle (LV): P=0.19; pulmonary artery systolic pressure (PASP): P=0.93; left ventricular ejection fraction (LVEF): P=0.89]. From the perspective of postoperative complications, the combined operation did not increase the incidence of respiratory-related complications (P=0.87) or cardiovascular-related complications (P=0.72) and secondary surgical events (P=0.19), but it did increase the incidence of surgery-related complications (such as chylothorax and air leakage), 15.4%:2.6%, which was manageable. In terms of perioperative safety, intraoperative blood loss during the combined operation was manageable (580 mL:450 mL) and did not significantly prolong the operation time (P>0.05).

Conclusions: Off-pump CABG combined with pulmonary resection is safe during the perioperative period, and the incidence of postoperative complications is manageable, thus reducing overall hospitalization costs. However, combined surgery poses certain technical difficulties and should be performed at experienced institutions.