ASSOCIATION OF BRONCHIAL AND PHARYNGO-LARYNGEAL MALIGNANCIES - A REAPPRAISAL

Objective. The purpose of this study was to re-evaluate operative risk and probability for survival patients with a history of upper aerodig estive cancer, who underwent thoracotomy for presumed primary bronchog enic cancer. Our hypothesis was to consider any isolated lung opacity as a primary bronchogenic cancer. Methods. The cohort under investigat ion included 114 consecutive patients. Histology of bronchial cancer w as 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 p otentially 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%).Results. 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 w as 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 s tage I, 19.2% in stage II, and 30.2% in stage III). There was no diffe rence in survival with reference to the location of head and neck canc er (chi(2) = 3.412; 0.05 < P < 0.1) or chronology (Chi(2) = 0.005; P > 0.9). Conclusions. We conclude that isolated lung opacities in patien ts with previous or simultaneous head and neck cancer are most likely primary bronchogenic cancers. The acceptable operative mortality legit imizes surgical treatment despite an impaired 5-year survival; patient s with a previous voice-sparing operation are at increased risk for re spiratory complications and should be managed carefully.