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Thorac Cardiovasc Surg 2021; 69(07): 666-671
DOI: 10.1055/s-0040-1713112
Original Thoracic

Survival and Prognostic Analysis after Pulmonary Metastasectomy for Head and Neck Cancer

Wojciech Dudek
1   Department of Thoracic Surgery, University Hospital Erlangen, Erlangen, Germany
2   Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
,
Emad AlMoussa
2   Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
3   Department of Radiation Oncology, University Hospital Erlangen, Erlangen, Germany
,
Waldemar Schreiner
1   Department of Thoracic Surgery, University Hospital Erlangen, Erlangen, Germany
2   Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
,
Konstantinos Mantsopoulos
2   Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
4   Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital Erlangen, Erlangen, Germany
,
Horia Sirbu
1   Department of Thoracic Surgery, University Hospital Erlangen, Erlangen, Germany
2   Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
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Abstract

Background There is no consensus on the value of pulmonary metastasectomy (PM) for head and neck cancer (HNC). The aim of our single-institution study was to evaluate outcomes and to examine factors influencing 5-year survival of patients undergoing resections for HNC lung metastases.

Methods All HNC patients undergoing curative-intent PM between January 2008 and December 2018 were retrospectively analyzed. The impact of factors related to primary tumor, metastases, and associated therapy on patient survival was evaluated using the univariable Cox proportional hazard model. Cutoff values of continuous variables were determined by a receiver operating characteristic analysis.

Results In total, 44 patients (32 males and 12 females, with a median age of 65 years) underwent PM for metastatic HNC. There was one perioperative death, and major complications occurred in 2 (4.5%) patients. The median interval between the treatment of primary tumor and PM was 19.4 months (range: 0–151 months). Median size of the largest resected pulmonary lesion was 1.3 cm (range: 0.3–6.9 cm). Mean follow-up was 21 months (range: 0–123 months), and 5-year overall survival (OS) rate after the first PM was 41%. Resection was complete (R0) in all patients. Larger size of pulmonary metastasis (≥1.4 cm; hazard ratio: 4.49; 95% confidence interval: 1.79–11.27) was a significantly negative prognostic factor.

Conclusion Despite the lack of randomized controlled trials, PM for HNC is a reasonable therapeutic option with favorable survival in a selected population. In patients with larger pulmonary lesions, shorter OS after PM is to be expected.

Keywords

head and neck cancer - lung metastases - survival - pulmonary metastasectomy


Publication History

Received: 04 March 2020

Accepted: 01 May 2020

Article published online:
19 June 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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