Surgery Today

, Volume 47, Issue 7, pp 795–801 | Cite as

Outcomes of surgery for lung cancer in patients with atrial fibrillation as a preoperative comorbidity: a decade of experience at a single institution in Japan

  • Ryu Kanzaki
  • Toru Kimura
  • Tomohiro Kawamura
  • Soichiro Funaki
  • Yasushi Shintani
  • Masato Minami
  • Meinoshin Okumura
Original Article



To investigate the surgical outcomes of surgery for non-small cell lung cancer (NSCLC) in patients with atrial fibrillation (AF) as a preoperative comorbidity.


Among 805 patients who underwent surgery for NSCLC, 27 (3.4%) had a history of AF. We analyzed the perioperative and long-term outcomes of these 27 patients.


Fourteen patients (52%) had chronic AF and 13 (48%) had paroxysmal AF; being high rates of a comorbid illness. Nineteen patients (70%) underwent lobectomy, and 8 (30%) underwent sublobar resection. Ten patients (37%) received perioperative heparinization. There was no mortality. Other non-AF postoperative complications developed in 8 patients (30%), this incidence being higher than among the patients without AF (16%, 127 out of 778, p = 0.09). A thromboembolic event occurred in one patient (4%). With respect to the long-term outcomes, the 5-year overall survival and disease-free survival rates among the patients with AF were 70.3 and 60.8%, respectively, which were similar to those in the patients without AF (79.8 and 72.6%, p = 0.30 and 0.31).


Lung cancer surgery in patients with AF is safe and provides favorable long-term outcomes; however, thoracic surgeons should monitor these patients carefully for postoperative thromboembolic events.


Lung cancer Atrial fibrillation Surgery 


Compliance with ethical standards

Conflict of interest

We declare no conflicts of interest in association with this study.


  1. 1.
    Siegel R, Ma J, Zou Z, Jemal A. Cancer statistics, 2014. CA Cancer J Clin. 2014;64:9–29.CrossRefPubMedGoogle Scholar
  2. 2.
    Sawabata N. Prognosis of lung cancer patients in Japan according to data from the Japanese Joint Committee of Lung Cancer Registry. Respir Investig. 2014;52:317–21.CrossRefPubMedGoogle Scholar
  3. 3.
    Takamochi K, Oh S, Matsuoka J, Suzuki K. Risk factors for morbidity after pulmonary resection for lung cancer in younger and elderly patients. Interact CardioVasc Thorac Surg. 2011;12:739–43.CrossRefPubMedGoogle Scholar
  4. 4.
    JCS Joint Working Group. Guidelines for Pharmacotherapy of Atrial Fibrillation (JCS 2013). Circ J. 2014;78:1997–2021.CrossRefGoogle Scholar
  5. 5.
    Mokhles S, Verstegen N, Maat AP, Birim O, Bogers AJ, Mokhles MM, et al. Comparison of clinical outcome of st9.age I non-small cell lung cancer treated surgically or with stereotactic radiotherapy: results from propensity score analysis. Lung Cancer. 2015;87:283–9.CrossRefPubMedGoogle Scholar
  6. 6.
    Roselli EE, Murthy SC, Rice TW, Houghtaling PL, Pierce CD, Karchmer DP, et al. Atrial fibrillation complicating lung cancer resection. J Thorac Cardiovasc Surg. 2005;130:438–44.CrossRefPubMedGoogle Scholar
  7. 7.
    Committee for the Third Edition of the COPD Guidelines of The Japanese Respiratory Society. Guidelines for the diagnosis and treatment of COPD (chronic obstructive disease), 3rd edn. Nihon Kokyuki Gakkai Zasshi 2009; Suppl Copd.Google Scholar
  8. 8.
    Japanese nephrology society. Clinical practice guidebook for diagnosis and treatment of chronic kidney disease 2012. Nihon Jinzo Gakkai Shi. 2012;54:1034–191.Google Scholar
  9. 9.
    Gage BF, Waterman AD, Shannon W, Boechler M, Rich MW, Radford MJ. Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation. JAMA. 2001;285:2864–70.CrossRefPubMedGoogle Scholar
  10. 10.
    Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Katayama H, Kurokawa Y, Nakamura K, Ito H, Kanemitsu Y, Masuda N, et al. Extended Clavien–Dindo classifications of surgical complications: Japan Clinical Oncology Group postoperative complications criteria. Surg Today. 2016;46:668–85.CrossRefPubMedGoogle Scholar
  12. 12.
    Vaughan Williams EM. Classification of antiarrhythmic drugs iSE, Flendsted-Jensen E, Olsen K teds: Symposium on Cardiac Arrhythmias. Sodertaije. Sweden AB Astra 1970; 449.Google Scholar
  13. 13.
    Ohsawa M, Okayama A, Sakata K, Kato K, Itai K, Onoda T, et al. Rapid increase in estimated number of persons with atrial fibrillation in Japan: an analysis from national surveys on cardiovascular diseases in 1980, 1990 and 2000. J Epidemiol. 2005;15:194–6.CrossRefPubMedGoogle Scholar
  14. 14.
    Watanabe H, Watanabe T, Sasaki S, Nagai K, Roden DM, Aizawa Y. Close bidirectional relationship between chronic kidney disease and atrial fibrillation: the Niigata preventive medicine study. Am Heart J. 2009;58:629–36.CrossRefGoogle Scholar
  15. 15.
    Gu J, Liu X, Tan H, Zhou L, Jiang W, Wang Y, et al. Impact of chronic obstructive pulmonary disease on procedural outcomes and quality of life in patients with atrial fibrillation undergoing catheter ablation. J Cardiovasc Electrophysiol. 2013;24:148–54.CrossRefPubMedGoogle Scholar
  16. 16.
    Moe GK, Abildskov JA. Atrial fibrillation as a self-sustaining arrhythmia independent of focal discharge. Am Heart J. 1959;58:59–70.CrossRefPubMedGoogle Scholar
  17. 17.
    Lubien E, DeMaria A, Krishnaswamy P, Clopton P, Koon J, Kazanegra R, et al. Utility of B-natriuretic peptide in detecting diastolic dysfunction: comparison with Doppler velocity recordings. Circulation. 2002;105:595–601.CrossRefPubMedGoogle Scholar
  18. 18.
    Lee SH, Jung JH, Choi SH, Lee N, Park WJ, Oh DJ, et al. Determinants of brain natriuretic peptide levels in patients with lone atrial fibrillation. Circ J. 2006;70:100–4.CrossRefPubMedGoogle Scholar
  19. 19.
    Imperatori A, Mariscalco G, Riganti G, Rotolo N, Conti V, Dominioni L. Atrial fibrillation after pulmonary lobectomy for lung cancer affects long-term survival in a prospective single-center study. J Cardiothorac Surg. 2012;7:4.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Hollings DD, Higgins RS, Faber LP, Warren WH, Liptay MJ, Basu S, et al. Age is a strong risk factor for atrial fibrillation after pulmonary lobectomy. Am J Surg. 2010;199:558–61.CrossRefPubMedGoogle Scholar
  21. 21.
    Roselli EE, Murthy SC, Rice TW, Houghtaling PL, Pierce CD, Karchmer DP, et al. Atrial fibrillation complicating lung cancer resection. J Thorac Cardiovasc Surg. 2005;130:438–44.CrossRefPubMedGoogle Scholar
  22. 22.
    Inoue H, Nozawa T, Hirai T, Iwasa A, Okumura K, Lee JD, et al. Accumulation of risk factors increases risk of thromboembolic events in patients with nonvalvular atrial fibrillation. Circ J. 2006;70:651–6.CrossRefPubMedGoogle Scholar
  23. 23.
    Murasaki K. Guidelines for management of anticoagulant and antiplatelet therapy in cardiovascular disease (JCS 2009). Nihon Rinsho. 2011;69(Suppl 9):567–71.PubMedGoogle Scholar
  24. 24.
    Sonobe M, Sato T, Chen F, Fujinaga T, Shoji T, Sakai H, et al. Management of patients with coronary stents in elective thoracic surgery. Gen Thorac Cardiovasc Surg. 2011;59:477–82.CrossRefPubMedGoogle Scholar
  25. 25.
    Douketis JD, Spyropoulos AC, Kaatz S, Becker RC, Caprini JA, Dunn AS, et al. Perioperative Bridging Anticoagulation in Patients with Atrial Fibrillation. N Engl J Med. 2015;373:823–33.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Japan 2016

Authors and Affiliations

  • Ryu Kanzaki
    • 1
  • Toru Kimura
    • 1
  • Tomohiro Kawamura
    • 1
  • Soichiro Funaki
    • 1
  • Yasushi Shintani
    • 1
  • Masato Minami
    • 1
  • Meinoshin Okumura
    • 1
  1. 1.Department of General Thoracic SurgeryOsaka University Graduate School of MedicineSuitaJapan

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