Head and neck cancer surgery in an elderly patient population: a retrospective review

Yang, Ru; Lubek, Joshua E.; Dyalram, Donita; Liu, X.; Ord, Robert A.

doi:10.1016/j.ijom.2014.08.008

Cited by 35 publications

(16 citation statements)

References 21 publications

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“…[3][4][5] Twenty-five percent of cases of head and neck squamous cell carcinoma (HNSCC) are in patients > 70 years of age. 6,7 Additionally, the management of this patient population is particularly challenging because the median survival of patients with recurrent HNSCC is < 2 years. 8 In patients with recurrence, surgery offers the best chance of achieving locoregional control and prolonged survival; however, careful patient selection is essential to optimize benefit while limiting unnecessary morbidity.…”

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confidence: 99%

Evaluation of the Relationship between Age and Outcome after Microvascular Reconstruction among Patients with Recurrent Head and Neck Squamous Cell Carcinoma

Patel

Stern

Miglani

et al. 2017

J reconstr Microsurg

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In patients with head and neck squamous cell carcinoma (HNSCC), disease recurrence remains a significant obstacle to long-term survival. If possible, surgical salvage with reconstruction remains the best treatment option for patients with recurrence. Currently, there is no literature discussing whether age should preclude microvascular reconstruction in these patients. We hypothesize that older age alone does not affect outcomes. A retrospective chart review of patients with HNSCC at our institution between 2008 and 2015 was performed. Patients were included if they underwent simultaneous resection and flap reconstruction for recurrent HNSCC. Data collected included age, sex, primary site, type of reconstruction, previous treatments, postoperative complications (systemic and reconstructive), and overall survival. A total of 65 patients met inclusion criteria for the review: 42 (64.6%) patients ≤70 years and 23 (35.4%) patients > 70 years. Overall survival was not significantly different between the younger and older groups ( = 0.199). Five-year survival was 60.1% in the younger group and 46.8% in the older group. No significant difference was found in reconstructive complication rates ( = 0.179) or systemic complication rates ( = 0.241) between the two groups. Multivariate logistic regression analysis further showed no significant association between patients' age (≤70 years or > 70 years) and reconstructive complications ( = 0.396) or systemic complications ( = 0.119). Age is not significantly associated with complications among patients undergoing resection and reconstruction for recurrent HNSCC. Microvascular reconstruction remains a feasible option in older patients with recurrent HNSCC. Advanced age alone should not preclude the surgical management of recurrent HNSCC.

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confidence: 99%

Evaluation of the Relationship between Age and Outcome after Microvascular Reconstruction among Patients with Recurrent Head and Neck Squamous Cell Carcinoma

Patel

Stern

Miglani

et al. 2017

J reconstr Microsurg

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“…Octogenarians are generally considered high-risk candidates for major surgeries. 4,7,8,11 Open skull base surgeries are prolonged, with a significant insult to an area that may have been previously treated with chemoradiotherapy or prior surgery and might require reconstruction with free flap/local tissue transfer, all of which are factors that may lead to higher postoperative morbidity and mortality rates. There are limited reports in the literature on outcomes after skull base for the octogenarian patient population, and the current study was conducted to address these issues.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Craniofacial Open Surgery in Octogenarians

et al. 2018

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Introduction The steady increase in average life expectancy has led to a rise in the number of referrals of elderly patients for major operations. It is not clear whether age itself is a risk factor for morbidity and mortality after skull base operations. We investigated a possible link among a cohort of patients older than 80 years of age who underwent those surgeries in our department. Methods We conducted a retrospective analysis of all patients who underwent skull base surgery at the TASMC (Tel Aviv Sourasky Medical Center) between 2000 and 2016. Results A total of 369 patients underwent open skull base surgeries in our institution, and 13 were patients older than 80 years. The median age of the octogenarians was 83.4 (range 80–89), and the male-to-female ratio was 7:6. Twelve patients had major systemic comorbidities. Four patients had major complications associated with surgery: three had early wound complications, and one each had early central nervous system complications, early and late systemic complications, and late orbital complications. This complication rate is comparable to that of our younger group of 356 patients. The overall survival rate was measured for 30 days, 1 year, and 3 years, and it was not significantly different between the octogenarians and that of the younger patients. Further comparison of the elderly group with 13 matched younger patients revealed no difference of morbidity and mortality between the two groups. Conclusions Despite their systemic comorbidities, the morbidity and mortality rates associated with skull base surgery in octogenarians appear to be comparable to that of younger patients undergoing the same procedures.

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“…From the literature, little is known about the effects of chemotherapy for HNC in these 90‐year‐old patients. To date, the number of reported cases of HNC, excluding skin cancer, in nonagenarians is small, with fewer than 16 patients treated by radiotherapy and eight individuals treated by surgery being accounted for. Yang et al .…”

Section: Discussionmentioning

confidence: 99%

“…To date, the number of reported cases of HNC, excluding skin cancer, in nonagenarians is small, with fewer than 16 patients treated by radiotherapy and eight individuals treated by surgery being accounted for 7,10,11 . Yang et al 11 reviewed 53 people aged ≥80 years (eight of whom were nonagenarians) treated with surgery for HNC. All studied subjects exhibited a pretreatment Eastern Cooperative Oncology Group performance status score between 0 and 2.…”

Section: Discussionmentioning

confidence: 99%

The ‘Primum Non‐Nocere’ management conundrum of head and neck cancer in the nonagenarian: case reports

et al. 2018

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There is a paucity of information regarding the management and outcome of nonagenarians with head and neck cancer. This retrospective study revealed oral cavity carcinoma in three 90‐year‐old people accounting for approximately 0.1% of patients evaluated for treatment of head and neck cancer during a period of over 3 years at a single institution. Resection of gross tumour performed in these individuals with early stage or locally advanced disease (two patients) resulted in survival with recurrent tumour at 28 months, disease‐free survival at 8 months and death during the early recovery period, respectively. Extreme chronological age should not necessarily preclude judiciously applied therapy in people with head and neck cancer. Therapeutic intervention needs to be individualized according to the presented clinical profile.

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Head and neck cancer surgery in an elderly patient population: a retrospective review

Cited by 35 publications

References 21 publications

Evaluation of the Relationship between Age and Outcome after Microvascular Reconstruction among Patients with Recurrent Head and Neck Squamous Cell Carcinoma

Evaluation of the Relationship between Age and Outcome after Microvascular Reconstruction among Patients with Recurrent Head and Neck Squamous Cell Carcinoma

Outcomes of Craniofacial Open Surgery in Octogenarians

The ‘Primum Non‐Nocere’ management conundrum of head and neck cancer in the nonagenarian: case reports

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