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Original Articles: General Thoracic

Pulmonary Metastasectomy for Pulmonary Metastases of Head and Neck Squamous Cell Carcinomas

^a Department of Thoracic Surgery, Yamagata Prefectural Central Hospital, Yamagata, Japan
^b Department of Thoracic Surgery, Keio University School of Medicine, Tokyo, Japan
^c Department of Chest Surgery, Cancer Institute Hospital, Tokyo, Japan
^d Department of Cardiothoracic Surgery, University of Tokyo, Tokyo, Japan
^e Department of Thoracic Surgery, Chiba University, Chiba, Japan
^f Department of First Surgery, Tokyo Medical University, Tokyo, Japan
^g Department of General Thoracic Surgery, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan
^h Department of Thoracic Surgery, Saitama Cancer Center, Saitama, Japan

Accepted for publication April 14, 2009.

^_* Address correspondence to Dr Shiono, Department of Thoracic Surgery, Yamagata Prefectural Central Hospital, 1800, Oazaaoyagi, Yamagata, 990-2292, Japan (Email: sshiono{at}ypch.gr.jp).

Background: The lung is the major organ for distant metastasis from head and neck cancers, and pulmonary metastasectomy is indicated for selected cases. The efficacy of surgical treatment for pulmonary metastatic lesions from head and neck cancers has not been thoroughly examined.

Methods: The database developed by the Metastatic Lung Tumor Study Group of Japan was retrospectively reviewed. Between November 1980 and September 2006, 237 patients underwent resection of pulmonary metastases from primary head and neck cancers. After excluding nonsquamous cell carcinomas, 114 cases were analyzed, and the survival and prognostic factors for pulmonary metastasectomy for metastases from head and neck cancers were determined.

Results: The overall 5-year survival rate after pulmonary metastasectomy was 26.5%, and the median survival time was 26 months. As determined by univariate analysis, poor prognostic factors were oral cavity cancers, lymph node metastasis, a disease-free interval of 24 months or less, and incomplete resection. Multivariate analysis revealed that poor prognostic factors were being male, having oral cavity cancers, lymph node metastasis, and incomplete resection. When patients were divided into males with oral cavity cancers (n = 17) and all others (n = 97), the 5-year survival rates were 0% and 31.6%, respectively. Survival of male patients with oral cavity cancer that metastasized was significantly reduced (p < 0.001).

Conclusions: Male sex, oral cavity cancers, lymph node metastasis, and incomplete resection were poor prognostic factors for pulmonary metastases, but there is the potential for a good surgical outcome in carefully selected patients.

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Invited Commentary

Frederic W. Grannis, Jr
Ann. Thorac. Surg. 2009 88: 861. [Extract] [Full Text] [PDF]

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				F. W. Grannis Jr Invited commentary. Ann. Thorac. Surg., September 1, 2009; 88(3): 861 - 861. [Full Text] [PDF]