Ann Thorac Cardiovasc Surg 2017; 23: 169–174
Original Article
Online May 9, 2017 doi: 10.5761/atcs.oa.16-00269
Surgical Treatment for Pulmonary Metastasis of Head and Neck Cancer: Study of 58 Cases Yuki Nakajima, MD, PhD,1 Yoshihito Iijima, MD, PhD,1 Hiroyasu Kinoshita, MD, PhD,1 Hirohiko Akiyama, MD, PhD,1 Takeshi Beppu, MD, PhD,2 Hidetaka Uramoto, MD, PhD,1,3 and Tomomi Hirata, MD, PhD1
Purpose: Although the number of surgeries performed for pulmonary metastasis of head and neck cancer has been increasing, there have been few reports of the surgical effectiveness. We collected the data of surgeries performed in our facility in order to discuss the surgical performance and indication. Methods: We retrospectively examined the prognosis and predictors for 58 patients with pulmonary metastasis of head and neck cancer who underwent a surgery in our facility during the 15-year period, from January 2000 to December 2015. Results: The 3-year and 5-year survival rates were 54.2% and 35.7%, respectively, and the median survival time was 42.2 months. The disease-free interval (DFI) was less than 24 months and patients with oral cavity cancer were poor prognostic factors. Conclusion: The effectiveness of surgical treatment for pulmonary metastasis of head and neck cancer was suggested. Keywords: oral cavity cancer, head and neck cancer, pulmonary metastasis, metastasectomy, surgical indication
Introduction According to the statistics of the Japanese Association for Thoracic Surgery in 2013, 424 patients underwent surgery for pulmonary metastasis of head and neck cancer. Pulmonary metastasis of head and neck cancer was the fourth most common disease for which surgical treat-
Division of Thoracic Surgery, Saitama Cancer Center, Kitaadachigun, Saitama, Japan 2Division of Head and Neck Surgery, Saitama Cancer Center, Kitaadachi-gun, Saitama, Japan 3Division of Thoracic Surgery, Kanazawa Medical University, Kanazawa, Ishikawa, Japan 1
Received: November 18, 2016; Accepted: February 1, 2017 Corresponding author: Yuki Nakajima, MD, PhD. Division of Thoracic Surgery, Saitama Cancer Center, 780 Komuro, Ina, Kitaadachigun, Saitama 362-0806, Japan Email: [email protected] ©2017 The Editorial Committee of Annals of Thoracic and Cardiovascular Surgery. All rights reserved.
Ann Thorac Cardiovasc Surg Vol. 23, No. 4 (2017)
ment was provided, after colorectal/rectal (3898 cases), renal cellular (608), and breast (456) cancer.1) However, since surgery for head and neck cancer has only been performed in a few medical facilities, this situation may be similar to surgery for pulmonary metastasis. Thus, the number of reports on pulmonary metastasis of head and neck cancer are limited. In this study, we collected the data from 58 patients who underwent surgery to remove pulmonary metastasis of head and neck cancer in our facility, in order to discuss the surgical performance and indication.
Materials and Methods For 58 patients with pulmonary metastasis of head and neck cancer who underwent initial surgery at our facility during the 15-year period, from January 2000 to December 2015, we retrospectively examined the prognosis and predictors. We examined epithelial malignant tumor with the primary lesion in the oral cavity, nasal 169
Nakajima Y, et al.
Table 1 Patients’ characteristics Characteristic of primary cancer Gender Male
Number (n = 58) 53
Female Site of primary cancers Oral cavity Nasal cavity and paranasal sinuses Nasopharynx Oropharynx
5
Hypopharynx Larynx Salivary gland Stage of primary cancer I II III IV Treatment for primary cancers Operation Chemoradiotherapy Histology Squamous cell carcinoma
17 15 4
Adenoid cystic carcinoma Mucoepidermoid carcinoma Carcinoma ex pleomorphic adenoma
6 1 2
9 2 3 8
2 7 16 33 51 7 49
cavity and paranasal sinuses, pharynx, larynx, and salivary gland, excluding thyroid cancer. In our facility, the indication for surgery was determined according to the Thomford’s criteria: 1) general status capable of undergoing lung surgery, 2) controlled primary lesion, 3) no metastasis in organs other than the lungs, or if present, such metastasis could be controlled by surgery or other treatments, and 4) pulmonary metastasis that can be completely removed.2) Partial resection of the lung is generally performed as a surgical procedure, and performed segmentectomy or lobectomy in the hilar region. All cases underwent an intraoperative frozen section diagnosis, and when any similarities with the primary site were observed, and then the occurrence of metastasis was considered to exist. When it was impossible to distinguish a lesion from the primary lung cancer, then lobectomy was performed in addition to mediastinal lymph node dissection. In 1998, we began to perform thoracoscopic surgery. In accordance with the 4th edition of the Japanese Classification of Head and Neck Cancer, the disease stage of the primary lesion was determined. For assessment of 170
Characteristic of metastatic lesions Age (at metastasectomy) Median (range) Number of tumors n=1 n=2 n ≥3 Largest tumor size (mm) Mean (range) Laterality Unilateral Bilateral Operation Wedge resection Segmentectomy Lobectomy Pneumonectomy Resection margin R0 R1 Disease-free interval Median (range) Adjuvant therapy Yes No
Number (n = 58) 65.2 (38–85) 43 10 5 22.5 (7–120) 53 5 39 7 11 1 58 0 21.5 (1–140) 20 38
survival and the significance of any difference, the Kaplan—Meier method and log-rank test were used, respectively. In multivariate analysis, the Cox proportional hazard regression model was used, and a significant difference was confirmed when p
Original Article
Online May 9, 2017 doi: 10.5761/atcs.oa.16-00269
Surgical Treatment for Pulmonary Metastasis of Head and Neck Cancer: Study of 58 Cases Yuki Nakajima, MD, PhD,1 Yoshihito Iijima, MD, PhD,1 Hiroyasu Kinoshita, MD, PhD,1 Hirohiko Akiyama, MD, PhD,1 Takeshi Beppu, MD, PhD,2 Hidetaka Uramoto, MD, PhD,1,3 and Tomomi Hirata, MD, PhD1
Purpose: Although the number of surgeries performed for pulmonary metastasis of head and neck cancer has been increasing, there have been few reports of the surgical effectiveness. We collected the data of surgeries performed in our facility in order to discuss the surgical performance and indication. Methods: We retrospectively examined the prognosis and predictors for 58 patients with pulmonary metastasis of head and neck cancer who underwent a surgery in our facility during the 15-year period, from January 2000 to December 2015. Results: The 3-year and 5-year survival rates were 54.2% and 35.7%, respectively, and the median survival time was 42.2 months. The disease-free interval (DFI) was less than 24 months and patients with oral cavity cancer were poor prognostic factors. Conclusion: The effectiveness of surgical treatment for pulmonary metastasis of head and neck cancer was suggested. Keywords: oral cavity cancer, head and neck cancer, pulmonary metastasis, metastasectomy, surgical indication
Introduction According to the statistics of the Japanese Association for Thoracic Surgery in 2013, 424 patients underwent surgery for pulmonary metastasis of head and neck cancer. Pulmonary metastasis of head and neck cancer was the fourth most common disease for which surgical treat-
Division of Thoracic Surgery, Saitama Cancer Center, Kitaadachigun, Saitama, Japan 2Division of Head and Neck Surgery, Saitama Cancer Center, Kitaadachi-gun, Saitama, Japan 3Division of Thoracic Surgery, Kanazawa Medical University, Kanazawa, Ishikawa, Japan 1
Received: November 18, 2016; Accepted: February 1, 2017 Corresponding author: Yuki Nakajima, MD, PhD. Division of Thoracic Surgery, Saitama Cancer Center, 780 Komuro, Ina, Kitaadachigun, Saitama 362-0806, Japan Email: [email protected] ©2017 The Editorial Committee of Annals of Thoracic and Cardiovascular Surgery. All rights reserved.
Ann Thorac Cardiovasc Surg Vol. 23, No. 4 (2017)
ment was provided, after colorectal/rectal (3898 cases), renal cellular (608), and breast (456) cancer.1) However, since surgery for head and neck cancer has only been performed in a few medical facilities, this situation may be similar to surgery for pulmonary metastasis. Thus, the number of reports on pulmonary metastasis of head and neck cancer are limited. In this study, we collected the data from 58 patients who underwent surgery to remove pulmonary metastasis of head and neck cancer in our facility, in order to discuss the surgical performance and indication.
Materials and Methods For 58 patients with pulmonary metastasis of head and neck cancer who underwent initial surgery at our facility during the 15-year period, from January 2000 to December 2015, we retrospectively examined the prognosis and predictors. We examined epithelial malignant tumor with the primary lesion in the oral cavity, nasal 169
Nakajima Y, et al.
Table 1 Patients’ characteristics Characteristic of primary cancer Gender Male
Number (n = 58) 53
Female Site of primary cancers Oral cavity Nasal cavity and paranasal sinuses Nasopharynx Oropharynx
5
Hypopharynx Larynx Salivary gland Stage of primary cancer I II III IV Treatment for primary cancers Operation Chemoradiotherapy Histology Squamous cell carcinoma
17 15 4
Adenoid cystic carcinoma Mucoepidermoid carcinoma Carcinoma ex pleomorphic adenoma
6 1 2
9 2 3 8
2 7 16 33 51 7 49
cavity and paranasal sinuses, pharynx, larynx, and salivary gland, excluding thyroid cancer. In our facility, the indication for surgery was determined according to the Thomford’s criteria: 1) general status capable of undergoing lung surgery, 2) controlled primary lesion, 3) no metastasis in organs other than the lungs, or if present, such metastasis could be controlled by surgery or other treatments, and 4) pulmonary metastasis that can be completely removed.2) Partial resection of the lung is generally performed as a surgical procedure, and performed segmentectomy or lobectomy in the hilar region. All cases underwent an intraoperative frozen section diagnosis, and when any similarities with the primary site were observed, and then the occurrence of metastasis was considered to exist. When it was impossible to distinguish a lesion from the primary lung cancer, then lobectomy was performed in addition to mediastinal lymph node dissection. In 1998, we began to perform thoracoscopic surgery. In accordance with the 4th edition of the Japanese Classification of Head and Neck Cancer, the disease stage of the primary lesion was determined. For assessment of 170
Characteristic of metastatic lesions Age (at metastasectomy) Median (range) Number of tumors n=1 n=2 n ≥3 Largest tumor size (mm) Mean (range) Laterality Unilateral Bilateral Operation Wedge resection Segmentectomy Lobectomy Pneumonectomy Resection margin R0 R1 Disease-free interval Median (range) Adjuvant therapy Yes No
Number (n = 58) 65.2 (38–85) 43 10 5 22.5 (7–120) 53 5 39 7 11 1 58 0 21.5 (1–140) 20 38
survival and the significance of any difference, the Kaplan—Meier method and log-rank test were used, respectively. In multivariate analysis, the Cox proportional hazard regression model was used, and a significant difference was confirmed when p
