Long-term survival after lung resection for non-small cell lung cancer with circulatory bypass: A systematic review

Objective: Resection of locally advanced non-small cell lung cancer using circulatory bypass is not frequently performed. The objective of this study was to systematically review the long-term survival associated with the published studies dealing with the performance of lung resections for non-small cell lung cancer using circulatory bypass. Methods: A systematic review of publications dealing with lung resections for non-small cell lung cancer under circulatory bypass spanning from January 1, 1990, to December, 31 2010, was performed using a PubMed search with specific inclusion and exclusion criteria. The primary end point collected was survival. Several other clinical variables were also collected and analyzed. Survival curves were calculated using the Kaplan-Meier method. Univariate comparisons of survival were performed using a Cox proportional hazard model. Multivariate analysis was carried out using a Cox regression model. Results: The search algorithm yielded 20 articles for the analysis. The overall 5-year survival was 37% (median, 36 ± 6 months). Survival was significantly higher when placement on bypass was planned (54%; median, 67± 19 months) as opposed to unplanned or emergency placement (11%; median, 19 ± 6 months; P = .006). Multivariate analysis demonstrated that the use of unplanned bypass was prognostic for a worse long-term survival (hazard ratio = 0.28; 95% confidence interval, 0.09-0.90; P = .033). The 30-day and 90-day perioperative mortalities were 0% and 1%, respectively. Conclusions: The literature over the past 2 decades demonstrates that favorable long-term survival for extended resections of locally advanced non-small cell lung cancer using circulatory bypass can be achieved. The use of unplanned cardiopulmonary bypass, though, seems to be prognostic of unfavorable long-term survival.