Open AccessUP-TO-DATE STRATEGY FOR SURGICAL TREATMENT OF CANCER PATIENTS WITH SEVERE CONCOMITANT CARDIOVASCULAR DISEASES
Author(s) -
Sergei S. Gerasimov,
М. И. Давыдов,
М. М. Давыдов
Publication year - 2018
Publication title -
rossijskij onkologičeskij žurnal
Language(s) - English
Resource type - Journals
eISSN - 2412-9119
pISSN - 1028-9984
DOI - 10.18821/1028-9984-2019-23-3-6-120-128
Subject(s) - concomitant , medicine , cancer , surgery , disease , prophylactic treatment , myocardial revascularization , revascularization , cause of death , coronary artery disease , myocardial infarction
. Surgical treatment of cancer patients with severe concomitant cardiovascular diseases (CVD) is still a debatable issue. Materials and methods. The study involved 170 cancer patients who had surgical operations. Most patients had coronary heart disease (CHD) as severe concomitant cardiovascular disease -133 cases (78.2%). Simultaneous surgeries were performed in 32 (18.8%) patients; step-by-step tactics was achieved in 138 (81.2%) patients. The study evaluated frequency of complications and mortality. Prophylactic efficiency of surgery for severe concomitant CVDs was determined, as well. The causes of deaths within long-term periods were analyzed, and 3- and 5-year survival was calculated by Kaplan-Meier method. Results. Frequency of complications and mortality in radically operated cancer patients accounted for 55.3% and 4.1%, respectively. A higher rate of complications was registered after simultaneous operations as compared with that after step-by-step tactics - 60% and 52.6% , respectively (р>0.05). Prophylactic efficiency of surgery for severe concomitant CVDs in total accounted for 92.4%. The most effective method for prophylactic myocardial revascularization was coronary bypass (CB) performed at the first step. The main cause of death of radically operated patients in the long-term period was tumor process progression - 31.7%, while CVDs caused much less deaths - 9.8% (р =0,001). 3 and 5-year survival accounted for 59% and 46%, respectively. Conclusions: Surgical treatment of severe concomitant CVDs of cancer patients is a highly effective method for prevention of severe cardiovascular complications. Step-by-step tactics is associated with less frequency of complications. Simultaneous surgery with minimal risk may be performed in a selected group of patient. In the long-term follow up period the main factors, which affected 3- and 5-year survival were the radical type of surgery and the advanced cancer process.