Pulmonary metastasectomy for head and neck cancers

Background: Distant metastases from carcinomas that arise from the head and neck region are infrequent. The most common site is the lung. To evaluate the results of resection of pulmonary metastases for head and neck cancers, we reviewed our own cases of these metastases, Methods: Between November 1966 and March 1995, 83 patients with pulmonary m etastases from head and neck cancers underwent 94 thoracic operations. All patients had obtained or had obtainable locoregional control of their prima ry head and neck cancers. Kaplan-Meier and Cox regression models were used to analyze the prognostic factors for survival after metastasectomy. Results: Median age was 53 years (range, 17-77), Fifty-nine were male and 2 4 were female. Forty-one patients had squamous cell cancers, and 36 had gla ndular tumors that consisted mostly of thyroid and adenoid cystic carcinoma s. The median disease-free interval from the time of treatment of the head and neck primary cancers to the development of pulmonary metastases was 27 months. Sixty-eight (82%) patients had complete resection. Overall operativ e mortality rate was 2%. Overall actuarial survival rate after metastasecto my was 50% at 5 years, patients with glandular tumors had a 5-year survival rate of 64% compared with 34% for patients with squamous cell cancers. Whe n the patients with glandular tumors were analyzed according to their histo logy, patients with adenoid cystic carcinomas had an 84% 5-year survival, b ut none remained disease-free. Patients with thyroid cancers fared similarl y whether they were treated medically or surgically. On multivariate analys is, the adverse prognostic factors for patients with squamous cell cancers were incomplete resection, age greater than 50 years, and disease-free inte rval less than or equal to 2 years. Conclusions: Approximately 30% of patients with pulmonary metastases from s quamous cell cancers of the head and neck who underwent complete resection of all their metastases can expect to achieve long-term survival. The role of pulmonary resection for patients with glandular turners is unclear.