La chirurgie pulmonaire vidéo-assistée a-t-elle un impact sur les complications postopératoires chez les patients avec un antécédent de cancer des voies aérodigestives supérieures ?

JCTCV:22(4)
Head and neck cancers (HNC) and lung tumors share the same risk factors, and their association, synchronous or metachronous, is frequently described. The aim of our study was to determine the postoperative complication rate in patients with a previous history of HNC, and to determine whether video-assisted thoracic surgery (VATS) decreases the risk of postoperative complications in these patients. We also investigated whether surgical management of the lung tumor before the HNC reduced the incidence of postoperative complications in synchronous presentations. This retrospective, single-center study was conducted at Marie Lannelongue Hospital. It included patients with a history of HNC who underwent a pulmonary resection between 2010 and 2017. We established two groups of patients, those operated by thoracotomy and those operated by VATS, and compared the postoperative complication rate between the two groups. There were 121 patients (77% men) with an average age of 64.7 ± 8.1 years. Of these patients, 61% (n = 74) underwent thoracotomy lung resection and 39% (n = 47) had VATS. The overall postoperative complication rate was 57% (n = 69), with 3.3% intrahospital mortality (n = 4). Use of VATS significantly reduced the rate of pneumonia (43.2% vs. 17%, p = 0.003) and respiratory distress syndrome (21.6% vs. 2.1%, p = 0.003) compared to thoracotomy. Swallowing disorders represented a risk factor for complications after pulmonary resection in this study (OR = 3.3 [1.1, 10.7]). Initial management of the pulmonary tumor did not significantly reduce the rate of postoperative complications. The complication rate after pulmonary resection in patients with a history of HNC is high. Video-assisted pulmonary resection reduces the rate of postoperative pneumonia. Swallowing disorders represent a risk factor for complications, and this must be taken into account in the management of these patients.