Bronchogenic cancer associated with head and neck tumors. Survival analysis of 194 patients.

We reviewed a series of 194 lung opacities presumed to be bronchogenic carcinomas occurring either simultaneously with (n = 46) or metachronously to (n = 148) a head and neck cancer. The purpose of the study was to evaluate the operative mortality and morbidity and to assess with a survival analysis whether the lung lesions actually were primary carcinomas or metastases of the head and neck cancer. Operation was contraindicated in 77 patients: 36 for metastatic spread, 5 for small-cell carcinoma, and 35 for respiratory insufficiency. The remaining 118 underwent operation: lobectomy for 82, pneumonectomy for 30, wedge resection for 1, and exploratory thoracotomy for 5. The operative mortality was 5%, and the nonfatal morbidity was 22%. The survival at 5 years for patients who underwent operation for bronchogenic cancer was 19.7% (27.2% for stage I, 19% for stage II, 4.5% for stage IIIA, and 0% for stage IIIB). The survival of these patients was not significantly different with respect to the synchronous or metachronous occurrence or the histologic classification (squamous or non-squamous). We conclude that, despite the poor survival, several of these lung lesions associated with a head and neck cancer were most likely a primary bronchogenic cancer. Surgical management is justified because of the observed postoperative mortality.