Surgical management of concomitant lung cancer and cardiovascular diseases: a multidisciplinary perspective

Lung cancer and cardiovascular diseases (CVDs) frequently coexist due to shared risk factors such as aging, smoking, and chronic inflammation. The growing prevalence of elderly surgical candidates with concomitant lung cancer and CVDs presents unique diagnostic and therapeutic challenges. This review explores current strategies for managing such patients, emphasizing the importance of individualized, multidisciplinary treatment planning. Advances in minimally invasive pulmonary resection and parenchymal -sparing surgery-such as segmentectomy-have expanded surgical options, especially in frail patients. Simultaneously, improvements in cardiovascular therapies, including transcatheter aortic valve implantation (TAVI), thoracic endovascular aortic repair (TEVAR), and off-pump coronary artery bypass grafting (OPCAB), have enabled safer, staged approaches. Guideline-directed preoperative risk assessment from Japanese, American, and European societies underscores the need for tailored sequencing of cardiac and oncologic interventions. In general, a staged approach with initial cardiac stabilization followed by pulmonary resection is preferred. However, simultaneous surgery, especially OPCAB combined with pulmonary resection, may be feasible in carefully selected patients. Additionally, the cardiac toxicity of immune checkpoint inhibitors and EGFR-TKIs must be considered when planning neoadjuvant treatment. Integrating cardiovascular expertise into thoracic oncology is crucial to optimizing outcomes in this complex population.