Effect of cancer on long-term survival after cardiac surgery

Aksoy Tamer, Arslan Ahmet Hulisi, Ustunsoy Hasim

Abstract

Background: The prevalence of patients requiring cardiac surgery with concurrent active cancer or a history of cancer is rising. This study aimed to evaluate the differences in post- cardiac surgery long-term survival between these patients and those without cancer and to identify the factors influencing survival.
Methods: This retrospective study included 38 patients with active cancer or a history of cancer (Group 1) and 45 patients without cancer (Group 2) who underwent cardiac surgery. Demographical and perioperative clinical data of the patients were retrieved from electronic patient records. Patients/relatives were contacted by phone to check their survival status.
Results: Postoperative in-hospital mortality was 5.3% (2/38) and 0.0% (0/45) in the Group 1 and Group 2, respectively (p = 0.207). The mean survival was significantly shorter for Group 1 when compared to Group 2 (93.6 ± 11.6 [95% CI, 70.8- 116.4] vs. 156.8±9.7 months [95% CI, 137.7-175.9], p<0.001). Multivariate analysis identified the presence of cancer (HR: 7.7, 95% CI: 1.6-36.8, p = 0.010), hospitalisation longer than one week (HR: 4.2, 95% CI: 1.2-14.9, p = 0.028), and fresh frozen plasma need (HR: 7.0, 95% CI: 1.8-27.5, p = 0.006) as significant independent predictors of worse survival outcome.
Conclusion: Patients with a history of cancer or active cancer can be operated with acceptable risk. The findings of this study suggest that cancer affects long-term survival after cardiac surgery, primarily due to cancer progression. It emphasises the need for a multidisciplinary approach to balance benefits of cardiac surgery with the prognosis of cancer and underlines the importance of future research for better clinical decision- making in these patients.