Abstract
Objective: The coexistence of concomitant lesions of the heart and lungs needed surgical intervention is increasing. Simultaneous cardiac surgery with pulmonary resection can solve the lesions at the same time, thus avoiding the second operation. However, concern exists regarding the potentially increased mortality and complication rate of simultaneous surgery and the adequacy of lung exposure during heart surgery. Therefore, we performed a meta-analysis to evaluate the perioperative mortality and complication rate of combined heart surgery and lung tumor resection.Methods: A comprehensive literature search was performed in July 2020. PubMed, Embase and Web of Science databases were searched to collect studies reported the perioperative outcomes of combined heart surgery and lung tumor resection. Two reviewers independently screened literatures, extracted data and assessed the risk of bias of included studies. Pooled proportion and its 95% confidence intervals (95% CI) was performed by R version 3.6.1 using the meta package.Results: A total of 536 patients from 29 studies were included in this analysis. Overall, the results of this meta-analysis showed that the pooled proportion of operative mortality was 0.01 (95% CI: 0.00, 0.03) and the pooled proportion of postoperative complications was 0.40 (95% CI: 0.24, 0.57) for patients underwent combined cardiothoracic surgery. Subgroup analysis by lung pathology revealed that, for lung cancer patients, the pooled proportion of anatomical lung resection was 0.99 (95% CI: 0.95, 1.00), and the pooled proportion of systematic lymph node dissection or sampling was 1.00 (95% CI: 1.00, 1.00). Subgroup analysis by heart surgery procedures found that the pooled proportion of postoperative complications of coronary artery bypass grafting (CABG) patients using off-pump method was 0.17 (95% CI: 0.01, 0.43), while the pooled proportion of on-pump method was 0.61 (95% CI: 0.38, 0.82).Conclusion: This study presented that combined heart surgery and lung tumor resection had a low mortality rate and an acceptable complication rate. Subgroup analysis revealed most lung cancer patients underwent uncompromised anatomical resection and mediastinal lymph node sampling or dissection during combined cardiothoracic surgery, and showed off-pump CABG could potentially reduce the complication rate compared with on-pump CABG. While further researches are still needed.
Perioperative outcomes of combined heart surgery and lung tumor resection: A systematic review and meta-analysis