继发性肝癌的双插管介入治疗

目的和方法转移性肝癌的血液供应除主要来源于肝动脉外亦有门静脉的参于，同时门静脉又是实体肿瘤肝内转移的途径，作者自1992年1月至1995年12月对20例继发性肝癌病人采用经腹行肝动脉和门静脉系统双插管的方法进行介入治疗。结果：8例癌胚抗原（CEA）增高的患者有6例持续下降。根据治疗前后的CT图象对比显示肿瘤缩小者13例，肿瘤缩小28％～72％，平均50％。全组平均生存时间l3.5个月，半年、1年及2年生存率分别为95％、65％和20％。结论：经肝动脉、门静脉双插管介入治疗方法安全、方便，易于推广，其临床治疗效果需进一步提高。     

继发性肝癌的双插管介入治疗

目的和方法：转移性肝癌的血液供应除主要来源于肝动脉卦亦有门静脉的参于，同时门静脉又是实体肿瘤肝内转移的途径，作者自1992年1月至1995年12月对20例继发性肝癌病人采用经腹行肝动脉和门静脉系统双插管的方法进行介入治疗。结果：8例癌胚抗原(CEA)增高的患者有6例持续下降。根据治疗前后的CT图象对比显示肿瘤缩小者13例，肿瘤缩小28％～72％，平均50％。全组平均生存时间13.5个月、半年、1年及2年生存率分别为96％、66％和20％。结论：经肝动脉、门静脉双插管介入治疗方法安全、方便，易于推广，其临床治疗效果需进一步提高。     

原发性肝癌合并肺转移的双重介入治疗的研究

目的探讨临床双重介入治疗原发性肝癌合并肺转移的临床效果。方法对40例晚期原发性肝癌合并肺转移的患者,采用经股动脉穿刺插管选择性经肝动脉分支和支气管动脉进行化疗栓塞术。结果原发性肝癌有效率为45%(18/40),肺转移灶有效率为40%(16/40)。原发性肝癌合并肺转移有效率为37.5%(15/40),半年和1年生存率分别为80%和37.5%。结论临床经肝动脉分支和支气管动脉双重联合介入治疗原发性肝癌合并肺转移是一种安全、有效的姑息性治疗方法。     

双介入治疗原发性肝癌

联合应用经股动脉插管肝动脉化疗栓塞术(TAE)和在B超引导下经皮肤肝穿刺瘤内注射无水酒精(PEI)治疗原发性肝癌42例,肿癌面积缩小≥50％26例(61.8％),30％～49％14例(33.3％),<30％或无变化2例(4.9％)。8例经双介入治疗后获Ⅱ期手术切除,占19.0％。半年、1年、2年、3年生存率分别为:92.8％、64.3％、26.2％、7.1％。作者认为:双介入治疗优势互补、疗效增加、是治疗原发性肝癌一种行之有效的方法。     

肝动脉、门静脉双管灌注化疗联合碘油乙醇注射治疗不能切除的原发性肝癌

目的：探讨肝动脉,门静脉双管灌注化疗联合碘油乙醇注射治疗不能手术切除的原发性肝癌的临床疗效。方法：138例经病理证实的不能手术切除的中晚期原发性肝癌患者,分为2组进行治疗：（1）经皮下埋植式药泵经肝动脉和门静脉双插管灌注化疗组（AVPC组,80例）;（2）经皮下埋植式药泵经肝动脉和门静脉双插管灌注化疗联合碘油乙醇注射治疗组（联合治疗组,58例）。结果：治疗后获得二期手术切除率为AVPC组2．5％,。联合治疗组12．1％（P＜0．05）,治疗后0．5,1,2年生存率AVPC组分别为56．3％,45．0％,21．2％。联合治疗线分别为81．0％,61．2％,39．6％,两组间0．1,1,2年生存率均有显著性差异（P＜0．05）,两组并发症率无明显差异,结论：联合治疗是治疗不能手术切除的原发性肝癌的有效方法,效果优于单纯双管灌注化疗。     

电凝固化合并肝动脉栓塞治疗不能切除的原发性肝癌

为了提高不能切除原发性肝癌的治疗效果,采用电凝固化合并肝动脉插管栓塞化疗治疗原发性肝癌30例。病变均为单发,大小6cm～13cm,平均7cm。位肝右叶21例,左叶9例,全部病例经细胞学证实。经6月～40个月随访,完全缓解11例(37％),部分缓解15例(50％)总有效率87％。作者认为电凝固化合并肝动脉插管栓塞化疗,对不能切除质发性肝癌是一可选择治疗方法。     

复发性肝癌的治疗策略

原发性肝癌(下称肝癌)手术切除后复发是肝癌治疗的难点之一，也是最终导致病人死亡的重要原因之一。大肝癌术后5年复发率高达80％，小肝癌为40％。50％，最早的在术后2个月复发，复发高峰在术后l。2年。目前，复发性肝癌可供选择的治疗方法主要有手术再切除、肝动脉插管化疗栓塞(TACE)、无水酒精注射(PEI)、射频热凝固、肝脏移植等。     

肝癌术后肝血管区域化疗与腹腔置管灌注化疗预防复发的临床研究

原发肝癌切除术后高复发率或转移率是影响肝癌术后远期疗效的主要因素,而复发或转移的原因相当复杂,与多种因素关系密切。作者等针对这一课题,自1987年3月～1996年3月对手术切除的246例肝癌病例,在其它综合治疗措施相同的条件下,分为经门静脉插管区域性汁划化疗70例;经门静脉+肝动脉双插管区域性计划化疗30例;经腹腔内游离置管计划灌注化疗86例;并设对照组60例,进行前瞻性临床研究。结果表明三种方法较对照组的1年复发率减少(P<0.05),5年生存率明显提高(P<0.05),其中双插管法和腹腔灌注法效果尤为显著。门静脉插管组、门静脉+肝动脉双插管组、腹腔内置管灌注组及对照组的一年复发率分别为28.6％、26.6％、27.9％和45.0％;三年复发率分别为64.3％、53.3.、51.1％和60.0％;五年复发率分别为82.8％、73/3％、72.1％和85％。一年生存率分别是74.3％、76.6％和60％;三年生存率分别是40％、43％、44.1％和30％;五年生存率分别是21.4％、33.3％、33.7％,和15％。以上结果显示肝癌术后经肝血管内区域化疗和经腹腔置管灌注化疗对提高疗效、改善预后起到了积极作用。本文对三种方法的理论依据进行了探讨,重点讨论了腹腔内置管灌注化疗的药代动力学特点,肯定其技术的合理性,效果的可靠性,是原发肝癌术后后续治疗措     

双介入疗法治疗中晚期肝癌34例分析

对34例中晚期肝癌患者采用了经导管肝动脉化疗栓塞术（TACE），术后2周，再联合应用超声引导下行经皮瘤内无水酒精注射术（PEI）的双介入方法的治疗。27例肿块有不同程度缩小，其中6例缩小≥5％，11例缩小25％～50％，10例缩小＜25％，总缩小率为79．4％，全组平均生存期为15．4个月，治疗后半年、且1年、2年生存率分别为85．3％、61．8％、42．2％。认为TACE联合应用PEI的双介入疗法是延长中晚期肝癌病人生命的一种积极有效的治疗措施。     

小肝癌的射频消融治疗

目的： 总结射频消融(RFA)治疗肿瘤直径≤5cm小肝癌的疗效和经验。方法： 从1999年9月-2005年5月期间，采用RFA治疗肿瘤直径≤5cm的原发性或转移性肝癌共130例, 其中原发性肝癌86例，转移性肝癌44例。18例结合肝动脉栓塞化疗，20例同时行RFA联合瘤内无水酒精注射术。结果：1，3年总累积存活率分别为91.3%，77.7%。治疗中7例发生并发症，分别为少量胆瘘、肠瘘、轻度皮肤灼伤，未发现与治疗相关的死亡。结论：RFA对肿瘤直径≤5cm的小肝癌是一种相对安全、有效的治疗方法，并有可能达到与手术切除相似的效果。     

Outcomes of primary liver cancer in children: an appraisal of experience

Introduction

Hepatoblastoma (HB) and hepatocellular carcinoma (HCC) are the most common primary liver cancers in children. Recent advances in management of pediatric liver cancer have improved disease-specific survival (DSS). This is a review of our experience with childhood liver malignancy over the past 3 decades.

Materials and Methods

A retrospective chart review from 1975 to 2005 identified patients who were 18 years old or younger with a histologically confirmed diagnosis of primary liver cancer. Patients were staged according to the Children's Cancer Group and Pediatric Oncology Group (CCG/POG) system. Patients were followed up prospectively through clinic visits and mail correspondence. Standard statistical methods were used for comparison, risk, and survival analyses.

Results

Fifty-two patients were confirmed to have primary liver cancers, where 24 (46%) patients had HB, 22 (42%) had HCC, 3 (6%) had sarcomas, and 3 (6%) had other histologies. Mean ages at presentation for HB and HCC were 3.2 and 13.1 years old, respectively. The most common presentations were abdominal mass (67%) and pain (40%). Most patients underwent major liver resection (n = 45, 87%), including: lobectomy (n = 25, 48%), and trisegmentectomy (n = 11, 21%). Three patients underwent liver transplantation (n = 3, 6%) for advanced local disease. Forty-five (87%) received primary or neoadjuvant and/or adjuvant chemotherapy. Patients had the following CCG/POG stages: I (n = 31, 60%), II (n = 6, 11.5%), III (n = 9, 17%), and IV (n = 6, 11.5%). Complete gross resection (stage I and II) was achieved in 37 (71%) patients. The perioperative mortality and morbidity rates were 0% and 29%, respectively. Patients with complete resection had significantly better 5-year DSS and median survival compared with incomplete gross resection: 62% vs 9% and 216 vs 18 months, P < .001. Patients treated during the period 1995-2005 had better 5-year DSS and median survival compared with those treated during 1975-1994: 68% vs 32% and 117 vs 27 months, P = .032. All 3 patients who underwent transplantation for conventionally unresectable disease are alive without disease recurrence (follow-up period, 1-15 years).

Conclusion

Complete resection of the pediatric primary liver tumors remains the cornerstone of treatment to achieve cure. Major liver resection can be performed with minimal perioperative mortality and morbidity. Patients with HB appeared to have better survival compared with patients with HCC, and there was significant improvement in the DSS of children treated in the recent decade. Liver transplantation in conjunction with chemotherapy may have an increasing role in the management of locally advanced primary liver cancers.     

Successful liver transplantation across the ABO incompatibility barrier in 6 cases of biliary atresia

Background

The problem of ABO-incompatible liver transplantation still remains unsolved in older children. In this article, we report on our experience of 6 successful ABO-incompatible liver transplantations in patients with biliary atresia.

Material and Methods

Six patients (ABO incompatibility type A→O:1 case, B→O:2 cases, A→B:3 cases) were enrolled in this study; 3 patients were aged approximately 1 year and the other 3 ranged in age from 9 to 24 years at the time of transplantation. Each patient received perioperative plasma exchange, until the anti-donor blood-type antibody titers became less than 1:16, and also systemic multidrug immunosuppressive therapy (cyclophosphamide, prednisolone, and tacrolimus). We applied the protocol of intraportal infusion therapy (local administration of prostaglandin E₁, steroid, and gabexate mesilate via a portal vein catheter), splenectomy, and rituximab administration for the older group.

Results

Both the patient and graft survival rates remain at 100%, with the follow-up period of the patients ranging from 12 and 123 months. Acute cellular rejection occurred in 2 cases, and both were steroid sensitive. There was no incidence of humoral rejection. Although all cases developed viral infection, all recovered uneventfully with the administration of antiviral agents.

Conclusion

ABO-incompatible liver transplantation can be performed with a low risk of humoral rejection or late biliary complications using this combined antirejection strategy, even in older children.     

Late recurrence of hepatocellular carcinoma after liver transplantation: is an active surveillance for recurrence needed?

Introduction

Liver transplantation (OLT) is considered the most efficient therapeutic option for patients with liver cirrhosis and early stage hepatocellular carcinoma (HCC) in terms of overall survival and recurrence rates, when restrictive selection criteria are applied. Nevertheless, tumor recurrence may occur in 3.5% to 21% of recipients. It usually occurs within 2 years following OLT, having a major negative impact on prognosis. The efficacy of active posttransplantation surveillance for recurrence has not been demonstrated, due to the poor prognosis of recipients with recurrences.

Aim

To analyze the clinical, pathological, and prognostic consequences of late recurrence (>5 years after OLT).

Method

We analyzed the clinical records of 165 HCC patients including 142 males of overall mean age of 58 ± 6.9 years who underwent OLT between July 1994 and August 2011.

Results

Overall survival was 84%, 76%, 66.8%, and 57% at 1, 3, 5, and 10 years, respectively. Tumor recurrence, which was observed in 18 (10.9%) recipients, was a major predictive factor for survival: its rates were 72.2%, 53.3%, 26.7%, and 10% at 1, 3, 5, and 10 years, respectively. HCC recurrence was detected in 77.8% of patients within the first 3 years after OLT. Three recipients (100% males, aged 54-60 years) showed late recurrences after 7, 9, and 10 years. In only one case were Milan criteria surpassed after the examination of explanted liver; no vascular invasion was detected in any case. Recurrence sites were peritoneal, intrahepatic, and subcutaneous abdominal wall tissue. In all cases, immunosuppression was switched from a calcineurin-inhibitor to a mammalian target of rapamycin inhibitor. We surgically resected the extrahepatic recurrences. The remaining recipient was treated with transarterial chemoembolization with doxorubicin-eluting beads and sorafenib. Prognosis after diagnosis of recurrence was poor with median a survival of 278 days (range, 114-704).

Conclusions

Global survival, recurrence rate, and pattern of recurrence were similar to previously reported data. Nevertheless, in three patients recurrence was diagnosed >5 years after OLT. Although recurrence was limited and surgically removed in two cases, disease-free survival was poor. Thus, prolonged active surveillance for HCC recurrence beyond 5 years after OLT may be not useful to provide a survival benefit for these patients.     

Clinicopathologic features of gastric cancers producing alpha-fetoprotein

BACKGROUND: Patients with gastric cancers producing alpha-fetoprotein (AFP) were reported to have a poor prognosis with high rates of liver metastasis. The purpose of the present study was to clarify the clinicopathological features of AFP-producing gastric cancers, in particular characteristics of liver metastasis, and to evaluate treatment of these cancers. METHODS: In 27 of the 29 cases with elevated preoperative serum AFP levels among a total of 974 primary gastric cancers, AFP production was confirmed in gastric cancer cells by immunohistochemistry. These cases were included in the AFP-positive gastric cancer group (AFP(+), 2.7%). The remaining 945 cases with normal serum AFP levels were designated the AFP-negative gastric cancer group (AFP(-)). RESULTS: There was a higher incidence of lymph node metastasis, a deeper invasion of the gastric wall, a higher frequency of advanced stage, a more marked lymphatic invasion and a higher rate of liver metastasis in the AFP(+) group than in the AFP(-) group. The patients received curative resection in AFP(+) group had a significantly worse survival rates in comparison to that in AFP(-) group. With respect to liver metastasis (n = 17) in AFP(+) group, of 3 cases who received curative hepatic resection, 1 patient survived more than 3 years, while the remaining 2 died in less than 3 years due to multiple liver recurrence. The patients (n = 5) who received palliative resection for liver metastasis followed by transarterial continuous infusion chemotherapy all died in less than 1 year. CONCLUSION: AFP-producing gastric cancers had aggressive behavior and their clinical or biological features were quite different from the common AFP-negative gastric cancers. Surgical resection of liver metastasis from AFP-producing gastric cancers was unsatisfactory. The development of a novel multimodal therapy against AFP-producing gastric cancers is needed.     

ChildA级单个直径≤5cm肝细胞肝癌行肝移植与肝切除的预后比较

目的比较ChildA级、单个、直径≤5cm肝细胞肝癌行肝移植与肝切除术的预后。方法回顾性分析笔者所在医院肝移植中心2007～2011年期间行肝切除术及肝移植术的ChildA级、单个、直径≤5cm肝细胞肝癌患者的临床资料,比较2组患者术后无瘤生存率及总体生存率。结果本研究共纳入263例患者,其中肝移植组36例,肝切除组227例。肝移植组与肝切除组患者术后1、3及5年无瘤生存率分别为91．7％、85．3％及81．0％和80．6％、59．8％及50．8％,肝移植组高于肝切除组（P=-0．003）;术后1、3及5年总体生存率分别为100％、87．5％及83．1％和96．9％、83．8％及76．1％,2组间差异无统计学意义伊=0．391）。以肿瘤直径〈3em为标准再予以分析,其肝移植组与肝切除组术后1、3及5年无瘤生存率分别为92．3％、92．3％及92．3％和80．2％、62．5％及50．5％,肝移植组高于肝切除组（P=-0．019）;术后1、3及5年总体生存率分别为100％、91．7％及91．7％和97．7％、87．5％及79．5％,2组间差异也无统计学意义（p0．470）。结论ChildA级、单个、直径≤5cm肝细胞肝癌患者肝切除术后复发率高于肝移植,但两种治疗方式的术后总体生存率相似。     

Pediatric liver transplantation: the University of Padua experience

OBJECTIVE: The objective of this study was to analyze experience on pediatric liver transplantation (LT) between June 1993 and September 2006, including split liver transplantation (SLT), living donor liver transplantation (LDLT), and auxiliary partial orthotopic liver transplantation (APOLT). Furthermore, hepatocyte transplantation (HT) had a role in one patient with metabolic disease. METHODS: From November 1990 to September 2006, 657 LTs were performed including 63 pediatric LTs (9.6%) in 57 patients (32 boys and 25 girls). Six were retransplantations (9.5%). Thirty-two patients (57%) were younger than 5 years. The types of graft included the following: 26 whole organs (41%), 32 in situ split organs (51%), 4 reduced-size organs (6%), and 1 graft from a living donor (2%). Two patients received an APOLT, 4 patients received a combined kidney-liver transplantation (CKLT), and 1 patient received HT. Of the 63 pediatric LTs, 16 were behaved to be highly urgent (25%). RESULTS: Overall 1-, 3-, 5-, and 10-year patient survival rates were 82%, 82%, 78%, and 78%, respectively. Overall 1-, 3-, 5-, and 10-year graft survival rates were 76%, 76%, 72%, and 72%, respectively. In patients younger than 1 year, the 5-year survival rate was 100%. Perioperative mortality was 8.8%. Vascular complications occurred in 4 patients (6.3%). Six children required retransplantation due to primary nonfunction (PNF) in 4 cases (7%) and vascular thrombosis in 2 cases (3.5%). CONCLUSIONS: Cholestatic liver disease and age younger than 1 year were the best prognostic factors for excellent survival.     

射频消融治疗转移性肝癌的临床疗效

目的探讨RFA治疗转移性肝癌的临床疗效。方法回顾性分析2004年1月至2008年12月第三军医大学西南医院收治的87例行RFA治疗的消化系统肿瘤肝转移患者的临床资料。其中结肠癌肝转移34例,直肠癌肝转移33例,胰腺癌肝转移12例,胃癌肝转移8例。采用生命质量评分和KPS评分分析患者情况。采用电话和门诊随访。术后6个月每月行超声造影或CT检查、复查肝功能和肿瘤标志物等。6个月后每2个月复查1次。随访时间截至2013年11月。计数资料采用矿检验或秩和检验。采用Kaplan—Meier法绘制生存曲线,生存率比较采用Log—rank检验。结果87例患者中84例成功施行RFA治疗,3例因患者无法耐受疼痛放弃RFA治疗,其中结肠癌2例、胃癌1例。84例患者中,共存在129个转移癌;经过RFA治疗后,107个转移癌经1次RFA后超声造影显示完全无强化,转移瘤1次完全毁损率达82．95％（107／129）;另22个转移癌因第1次RFA后有残留,均接受2次RFA治疗后被完全毁损。患者住院时间为（10．7±2．3）d（4～29d）。治疗前生命质量评分：60．7％（51／84）良好,22．6％（19／84）较好,10．7％（9／84）一般,6．0％（5／84）差;KPS评分：63．1％（53／84）改善,29．8％（25／84）稳定,7．1％（6／84）下降。治疗6个月生命质量评分（排除15例死亡患者）：78．2％（54／69）良好,11．6％（8／69）较好,5．8％（4／69）一般,4．4％（3／69）差。KPS评分：73．9％（51／69）的患者改善,21．7％（15／69）稳定,4．4％（3／69）下降。治疗前后患者生命质量及KPS评分差异均有统计学意义（,=29．760,17．140,P〈0．05）。全部患者均获随访,随访时间6～60个月。结肠癌肝转移患者进行RFA治疗后1、3、5年的生存率分别为68．8％、21．9％、6．3％,中位生存时间为21．5个月;直肠癌肝转移患者进行RFA治疗后1、3、5年的生存率分别为66．7％、27．3％、12．1％,中位生存时间为19．5个月;胰腺癌肝转移患者进行RFA治疗后1、3、5年的生存率分别为41．7％、0和0,中位生存时间为8．5个月;胃癌肝转移患者进行RFA治疗后1、3、5年的生存率分别为71．4％、14．3％和0,中位生存时间为16．5个月。胰腺癌肝转移与胃癌肝转移患者接受RFA治疗后生存率显著低于结直肠癌患者（X2=9．169,P〈0．05）。结论对无法手术切除或者肝转移癌较小的患者,RFA是较为有效的治疗方案,可延长患者生存时间,改善生命质量。     

Surgical treatment for the recurrence of colorectal cancer

We report the results of a retrospective study conducted on patients who developed recurrence following surgery for colorectal cancer, and present a practical plan to improve the survival rates. Of 974 patients who underwent surgery for colorectal cancer in our hospital during the 20 years between 1974 and 1993, 152 developed recurrence, as local recurrence in 70 (7.2%), as liver metastasis in 47 (4.8%), and as pulmonary metastasis in 35 (3.6%). The number of patients who underwent reoperation or curative resection was 54 (77.1%) and 13 (24.1%), respectively, of those with local recurrence, 16 (34.0%) and 6 (37.5%) of those with liver metastasis, and 6 (17.1%) and 6 (100.0%) of those with pulmonary metastasis. The 3- and 5-year survival rates were 13.4% and 8.9%, respectively, after reoperation for local recurrence, 14.4% and 0%, after reoperation for liver metastasis, and 53.3% and 53.3% after reoperation for pulmonary metastasis. Although evaluation was difficult owing to the small number of patients with lung metastasis, resection of a pulmonary lesion resulted in a good outcome. Furthermore, a significant difference in 3- and 5-year survival rates was observed between patients who underwent reoperation and those who underwent conservative treatment, for whom the survival rates were 0% and 0% following local recurrence, 4.6% and 0% following liver metastasis, and 0% and 0% following lung metastasis, at 3 and 5 years, respectively. These findings indicate that aggressive surgery for recurrence may result in a better outcome.     

Indications for portal vein embolization combined with major hepatic resection for advanced-stage hepatocellular carcinomas. A preliminary clinical study

BACKGROUND: Criteria for selection of patients for portal vein embolization (PVE) before major hepatectomy for advanced-stage hepatocellular carcinoma (HCC) have not been clarified in detail. This study was aimed at defining those benefiting from this therapy in a retrospective fashion. PATIENTS AND METHODS: Firstly, to determine liver functional criteria for applying this approach 26 patients with stage III (17 patients) or IV (9 patients) disease, who underwent major hepatectomies after PVE, were divided into those without major complications (20 patients) and a postoperative liver failure group (6 patients). Clinical, analytical, and hemodynamic parameters obtained before and after PVE were compared between the groups. Secondly, to define the application of this approach with regard to tumor progression survival rates of patients were also obtained, taking into account factors which affect tumor development, i.e. lesion size, intrahepatic metastasis and vascular invasion. RESULTS: With regard to liver function 4 nonindications were obtained: (1) a portal pressure measured right after PVE >25 cm H(2)O; (2) post-PVE serum hyaluronate >200 ng/ml; (3) pre-PVE serum cholinesterase <150 U/l; (4) post-PVE serum cholinesterase <150 U/l. In view of the tumor progression in patients with HCCs featuring intrahepatic metastasis spread to more than 3 segments (IM3) 1-, 3- and 5-year survival rates were low (42.9, 28.6 and 0%) with a statistical significance, compared to those in patients with intrahepatic metastasis limited in the same lobe (76.9, 46.2 and 24.6%). CONCLUSIONS: When laboratory data fulfill 3 or more of the criteria, the extent of hepatic resection may have to be carefully reconsidered. Patients with HCCs featuring IM3 intrahepatic metastasis may not benefit from the aggressive approach described here.     

Squamous cell carcinoma of the head and neck and pulmonary cancer. Report of 50 cases

Association of a squamous cell carcinoma of the head and neck and a pulmonary cancer is frequent: prevalence is about 5 to 10 percent. The purpose of this study was to present the survival analysis of 50 patients, previously treated for a squamous cell carcinoma of the head and neck, and then treated for a pulmonary cancer between 1979 and 1996. Four patients were excluded from the analysis. Five pulmonary cancers were synchronous with the head and neck cancer, 41 were metachronous. Metachronous pulmonary cancer was asymptomatic in 87 percent and the mean interval between the two cancers was 53 months. Surgery was performed for every pulmonary cancer. Operative mortality was 11 percent. The overall 5-year survival rate was 25%. Survival rates were linked with the T and N stages of the pulmonary cancer: 46% for T1, 13% for T2 and 0% for T3 and T4, 67% for N0 ans 0% for N1-3. Indications for surgical treatment of synchronous and metachronous pulmonary cancers are discussed.