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Ann Thorac Surg 2006;82:1982-1988
© 2006 The Society of Thoracic Surgeons

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Original Articles: General Thoracic

Increased Risk of Aspiration and Pulmonary Complications After Lung Resection in Head and Neck Cancer Patients

Department of Thoracic and Cardiovascular Surgery, University of Texas, M. D. Anderson Cancer Center, Houston, Texas

Accepted for publication June 2, 2006.

^_* Address correspondence to Dr Mehran, MD, Department of Thoracic and Cardiovascular Surgery, 1515 Holcombe Blvd, Box 445, Houston TX 77030 (Email: rjmehran{at}mdanderson.org).

Presented at the Forty-second Annual Meeting of The Society of Thoracic Surgeons, Chicago, IL, Jan 10–Feb 1, 2006.

BACKGROUND: Patients with head and neck cancers (HNCs) may have impaired deglutition and airway protection. The risk of pulmonary complications after lung resection has not been evaluated in HNC patients. We therefore reviewed the risk of aspiration-related pulmonary complications in HNC patients after pulmonary resection.

METHODS: Retrospective review of a prospectively collected database from a single institution identified 1633 patients who underwent pulmonary resection for suspected primary lung cancer from 1997 to 2004. Of these, 76 patients had a history of HNC. The remaining 1557 patients were defined as controls. Categoric variables were analyzed with the ² test. Univariate and multivariate logistic regression analyses determined the variables related to aspiration pneumonia after pulmonary resection.

RESULTS: Aspiration pneumonia occurred in 7 HNC patients (9.2%) versus 10 patients (0.6%) in the control group (p < 0.001). In the entire population with pulmonary resection, HNC history (p < 0.001; odds ratio (OR), 17.5; 95% confidence interval (CI), 6.0 to 50.6), and postoperative recurrent laryngeal nerve paralysis (p < 0.001; OR, 27.8; 95% CI, 5.2 to 148) were independent risk factors for aspiration pneumonia after pulmonary resection. Length of stay was longer in patients with aspiration pneumonia, with a median of 30 days (range, 10 to 258) versus 6 days (range, 0 to 374; p = 0.021). In the HNC patients, prior recurrent laryngeal nerve paralysis was predictive of aspiration pneumonia (p = 0.034; OR, 8.8; 95% CI, 1.1 to 65.4).

CONCLUSIONS: Patients with HNC have an increased risk of aspiration pneumonia after pulmonary resection. Evaluation of swallowing function to identify aspiration is indicated in HNC patients before pulmonary resection to avoid the morbidity and prolonged hospitalization associated with aspiration pneumonia.

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