Perioperative Outcomes and Survival Patterns After Resection of Primary Salivary Gland Tumors of the Lung and Trachea
Chad S. Eckard, Matthew J. Schuchert, James R. Landreneau, David D. Odell, Joseph J. Wizorek, Kristen N. McCormick, James D. Luketich, Rodney J. Landreneau, University of Pittsburgh Medical Center, Pittsburgh, PA
OBJECTIVE: Primary salivary gland tumors of the respiratory system represent a rare constellation of low grade neoplasms that can arise as an endobronchial lesion or a solitary parenchymal nodule. There are multiple histologic variants of this tumor, including adenoid cystic carcinoma, epithelial-myoepithelial carcinoma, and mucoepidermal carcinoma. This study evaluates the clinical outcomes after operative resection of primary salivary gland tumors involving the airway and lung parenchyma.
METHODS: We retrospectively reviewed 20 cases of primary salivary gland tumors involving the lung (n=11) and airways (n=9) from 1994-2012. Operative interventions in this study included YAG laser ablation (n=3), wedge resection (n=1), lobectomy (n=6), sleeve resection with bronchoplasty (n=5), bi-lobectomy (n=1), and tracheal resection (n=4). Survival was calculated utilizing the Kaplan-Maier method.
RESULTS: Mean patient age was 55 ±16 years. Gender distribution was 7 males:13 females. Tumor histology was adenoid cystic (n=7, 35%), epithelial-myoepithelial (n=3, 15%), and mucoepidermal carcinomas (n=10, 50%). Complications occurred in 11 (55%) patients, with no peri-operative deaths. Recurrence was seen in 4 (20%) patients. The majority of recurrences were local (n=3 adenoid cystic, 75%), with only one case of metastatic disease (epithelial-myoepithelial, parenchymal). Freedom from recurrence and overall survival was 73% and 85% at ten years, respectively (Figure).
CONCLUSIONS: Complete surgical ablation/resection affords excellent oncologic outcomes in this group of rare tumors, which exhibit a low histologic grade and reduced metastatic potential. Adenoid cystic carcinoma is associated with a higher local recurrence rate.