ALGORITHM OF COMPLEX SURGICAL TREATMENT OF PATIENTS WITH TUMORS OF THE MAIN LOCATIONS AND CONCOMITANT CORONARY ARTERY DISEASE
Objectives. To evaluate the results of applying the algorithm of complex surgical treatment of patients with tumors of the main locations and concomitant coronary artery disease (CAD). Methods. The developed algorithm of complex surgical treatment is based on the determination of the least patient risk of cardio- and radical oncosurgical intervention with the choice of simultaneous or staged approach of treatment and the possibility of their conversion. According to the developed algorithm 93 patients (group 1) and 49 patients (group 2) have been simultaneous and staged operated, respectively. The coronary arteries bypass grafting (CABG) and radical intervention on the tumors of the main locations (lung, esophagus, stomach, kidney, uterus, adnexa of uterus) have been conducted within the period from 2001 to 2014. The patients of the first group seem to have more common malignant of lung (p=0,005), and the patients of the second group - gastric (p=0,07), esophageal (p=0,04) and colorectal (p=0,03) cancer. There was no any difference in the degree of heart failure and angina in patients of both groups. In the first group the operations on the “working heart” were significantly more performed and, accordingly, in the second - under cardiopulmonary bypass (p=0,001). Results. Overall hospital mortality of the first and second groups was 8,60% and 10,20%, respectively (p=0,76), a major hospital complications - 23,66% and 32,65% (p=0,35), from which cardiac ones - 6,45% and 11,63% (p=0,34). The five-year survival rate was 39,30±5,51% and 45,32±11,71% (p=0,20), median - 33,47 and 60,10 months, respectively. The corrected free survival averaged 72,45±7,86 and 64,08±11,14 months (p=0,51). Conclusion. The developed algorithm of complex surgical treatment of patients with tumors of the main locations and concomitant CAD takes advantages of simultaneous and staged approaches and provides good immediate and long-term results.