Background The best surgical treatment strategy for coexisting coronary artery disease (CAD) and lung cancer (LC) remains controversial. This study analyzed the safety and efficacy of a simultaneous minimally invasive procedure for patients with CAD and LC.

Methods Patients who underwent simultaneous minimally invasive off-pump coronary artery bypass grafting and lung resection from January 2016 to December 2021 were retrospectively analyzed. The procedure was performed in the fourth intercostal space through a small left anterolateral minithoracotomy. Harvesting of the left internal mammary artery (LIMA) and sewing of the anastomoses were performed under direct vision. Lung resections were performed with or without the assistance of a thoracoscope.

Results Sixteen patients were included with a mean age of 67.13 ± 10.61 years. Procedural success occurred in all patients with a mean operative time of 366.88 ± 94.48 minutes. All patients received at least one coronary artery bypass LIMA graft. Pneumonectomy, lobectomy, segment resection, and wedge resection were performed in one (6.25%), eight (50%), two (12.5%), and five (31.25%) patients, respectively. There were no perioperative deaths or new myocardial infarctions. Complications included one case of postoperative bleeding, two lung infections, two cases of atelectasis, one case of pleural effusion, and one case of cardiac arrhythmia. All the patients were followed up for 1 to 57 months, cancer recurrence occurred in two patients, and one patient died. The remaining patients showed no evidence of tumor recurrence or myocardial infarction.

Conclusion This simultaneous minimally invasive procedure is safe and effective for selected patients with CAD and LC.

背景 对于共存的冠状动脉疾病（CAD）和肺癌（LC）的最佳手术治疗策略仍然存在争议。本研究分析了同步微创手术治疗 CAD 和 LC 患者的安全性和有效性。

方法 对2016年1月至2021年12月期间接受微创非体外循环冠状动脉旁路移植术和肺切除术的患者进行回顾性分析。该手术是通过小型左前外侧小胸廓切开术在第四肋间进行的。在直视下进行左内乳动脉（LIMA）的收获和吻合术的缝合。在有或没有胸腔镜辅助的情况下进行肺切除术。

结果 16 例患者平均年龄为 67.13 ± 10.61 岁。所有患者均手术成功，平均手术时间为 366.88 ± 94.48 分钟。所有患者均接受至少一根冠状动脉旁路 LIMA 移植术。分别有 1 例（6.25%）、8 例（50%）、2 例（12.5%）和 5 例（31.25%）患者接受了全肺切除术、肺叶切除术、肺段切除术和楔形切除术。无围手术期死亡或新发心肌梗塞。并发症包括术后出血1例、肺部感染2例、肺不张2例、胸腔积液1例、心律失常1例。所有患者均获得随访，随访时间1～57个月，其中2例患者出现癌症复发，1例患者死亡。其余患者没有表现出肿瘤复发或心肌梗塞的证据。

结论 这种同步微创手术对于特定的 CAD 和 LC 患者是安全有效的。