International Society For Minimally Invasive Cardiothoracic Surgery

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VATS Lobectomy And Ablation As A Combined Treatment Of Lung Cancer And Atrial Fibrillation
Andrew C. Phillips, Gansevoort H. Dunnington.
St. Helena Hospital, St Helena, CA, USA.

<Background: In the preoperative workup for surgical atrial fibrillation (afib) ablation, potentially malignant lung nodules may be discovered. It is feasible to successfully manage lung cancer and atrial fibrillation concomitantly via a VATS approach. Methods: Retrospectively, in our institution from 2014-2017, three patients who came for a surgical ablation of atrial fibrillation were found to have cancerous lung nodules on pre-operative CT. Minimally invasive surgical treatment of both atrial fibrillation and lung cancer was performed concomitantly. We used a standard bilateral VATS approach for the ablation, followed by repositioning, re-prepping, and totally thoracoscopic lobectomy. Basic patient demographics were measured, intra-operative data was collected, and post-operative rhythm monitoring was conducted at 3 months, 12 months, and 24 months. Results: In our institution, three out of the 414 VATS afib ablations were performed concomitantly with a lobectomy procedure. In all three of these cases, there were no surgical complications. There was no incidence of TIA or stroke, despite being off of anticoagulation. Blood transfusions were not required, and there were no conversions to sternotomy nor thoracotomy. Average length of stay was 3.3 days and procedure time was 117 minutes. Currently, all three patients remain in normal sinus rhythm and exhibit no signs of cancer recurrence at a mean follow up of 472 days. $$GRAPHIC$$ Conclusions: In the hands of experienced surgeons, lung cancer and atrial fibrillation can be safely and successfully treated concomitantly, through a minimally invasive, VATS approach. A simultaneous approach may be advantageous to avoid delay of treatment or more complicated re-operative field for either pathology. LEGEND: Table 1: Average Demographics and Cancer Data (n=3)>


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