Association cancers de l’œsophage et des voies aérodigestives supérieures : implications thérapeutiques

Abstract

Aim of the study: To determine therapeutic and prognostic implications of an associated head and neck primary cancer in patients undergoing oesophagectomy for squamous cell carcinoma of the oesophagus. Patients and methods: Between 1982 and 2000, 868 patients with oesophageal cancer were operated in our institution, including 78 (9%) who underwent oesophagectomy for associated oesophageal and head and neck cancers; the latter was synchronous ( n = 52) or anterior metachronous ( n = 26). Influence of head and neck cancer on the treatment of oesophageal carcinoma was analysed retrospectively in terms of surgical therapeutic strategy and survival. Results: Oesophageal resection consisted of oeso-pharyngolaryngectomy ( n = 14, 17.9%), subtotal oesophagectomy ( n = 62, 79.5%) and cervical oesophagectomy ( n = 2, 2.6%). Radical resection (R0) was obtained in 85% of cases. Postoperative mortality rate was 5 % (4/78). Main complications were pulmonary (18% = 14/78) and anastomotic leaks (14% = 11/78), all of them cervical. Follow-up (mean = 25 ± 27 months) was complete for all 78 patients. Five-year survival after R0 resection was 25%. Survival pronostic factors were denutrition, complete resection, and pT status of oesophageal tumor. Conclusion: In patients with associated carcinomas of œsophagus and head and neck, agressive treatment —including an oesophagectomy— allowed a 5-year survival rate more than 25% without increased mortality or morbidity rates, compared with patients operated on for isolated œsophageal carcinoma.