Association of bronchial and pharyngo-laryngeal malignancies. A reappraisal

The purpose of this study was to re-evaluate operative risk and probability for survival patients with a history of upper aerodigestive cancer, who underwent thoracotomy for presumed primary bronchogenic cancer. Our hypothesis was to consider any isolated lung opacity as a primary bronchogenic cancer.

The cohort under investigation included 114 consecutive patients. Histology of bronchial cancer was squamous cell carcinoma in 98 patients (86%), adenocarcinoma in 14 (12%) and large cell carcinoma in 2 (2%). Exploratory thoracotomy was performed in 5 patients (4%); the remaining 109 patients underwent a potentially curative resection, including 25 pneumonectomies (22%) and 84 conservative resections (74%). Pathological staging was as follows: 66 stage I (58%), 20 II (17.5%), 20 IIIa (17.5%), 6 stage IIIb (5%), and 2 stage IV (2%).

Four patients died post-operatively (3.5%). Non-fatal morbidity concerned 32 patients (28.1%) and was dominated by respiratory superinfections. Incidence of respiratory infections was increased after voice-sparing resections (chi 2 = 4.311, P < 0.05), and more particularly after transmaxillary buccopharyngectomy (chi 2 = 12.224; P < 0.01). Estimated 5-year survival was 28.7% (33.3% in stage I, 19.2% in stage II, and 30.2% in stage III). There was no difference in survival with reference to the location of head and neck cancer (chi 2 = 3.412; 0.05 < P < 0.1) or chronology (chi 2 = 0.005; P > 0.9).

We conclude that isolated lung opacities in patients with previous or simultaneous head and neck cancer are most likely primary bronchogenic cancers. The acceptable operative mortality legitimizes surgical treatment despite an impaired 5-year survival; patients with a previous voice-sparing operation are at increased risk for respiratory complications and should be managed carefully.