Skip to main content Accessibility help
×
Home

Peri-operative outcomes following major surgery for head and neck cancer in the elderly: institutional audit and case–control study

  • N Subramaniam (a1), D Balasubramanian (a1), P Rka (a2), P Rathod (a1), S Murthy (a1), S Vidhyadharan (a1), S Rajan (a3), J Paul (a3), K Thankappan (a1) and S Iyer (a1)...

Abstract

Objective

Elderly patients have been consistently shown to receive suboptimal therapy for cancers of the head and neck. This study was performed to determine the peri-operative outcomes of these patients and compare them with those of younger patients.

Methods

In this retrospective analysis, 115 patients aged 70 years or more undergoing major surgery for head and neck cancers were matched with 115 patients aged 50–60 years, and univariate analysis was performed.

Results

Elderly patients had a reduced performance status (p < 0.001) and more co-morbid illnesses (p = 0.007), but a comparable intra-operative course. They had a longer median hospital stay (p = 0.016), longer intensive care unit stay (p = 0.04), longer median tracheostomy dependence (p = 0.04) and were more often discharged with feeding tubes (p < 0.001). They also had a higher incidence of post-operative non-fatal cardiac events (p = 0.045).

Conclusion

Elderly patients with good performance status should receive curative-intent surgery. Although hospital stay and tube dependence are longer, morbidity and mortality are comparable with younger patients.

Copyright

Corresponding author

Author for correspondence: Dr Deepak Balasubramanian, Department of Head and Neck Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala 682041, India E-mail: deepakbala@live.com

Footnotes

Hide All

Dr D Balasubramanian takes responsibility for the integrity of the content of the paper

Footnotes

References

Hide All
1Thiagarajan, S, Babu, TP, Chakraborthy, S, Patil, VM, Bhattacharjee, A, Balasubramanian, S. Head and neck cancer in geriatric patients: analysis of the pattern of care given at a tertiary cancer care center. Indian J Cancer 2015;52:387–9
2Ferlay, J, Soerjomataram, I, Ervik, M, Dikshit, R, Eser, S, Mathers, C et al. Globocan. Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11. Lyon: International Agency for Research on Cancer, 2012
3Smith, BD, Smith, GL, Hurria, A, Hortobagyi, GN, Buchholz, TA. Future of cancer incidence in the United States: burdens upon an aging, changing nation. J Clin Oncol 2009;27:2758–65
4Argiris, A, Eng, C. Epidemiology, staging, and screening of head and neck cancer. In: Brockstein, B, Masters, G, eds. Head and Neck Cancer. Boston: Springer, 2004;1560
5Pfister, DG, Ang, KK, Brizel, DM, Burtness, BA, Busse, PM, Caudell, JJ et al. Head and neck cancers, version 2.2013. Featured updates to the NCCN guidelines. J Natl Compr Canc Netw 2013;11:917–23
6Sanabria, A, Carvalho, AL, Vartanian, JG, Magrin, J, Ikeda, MK, Kowalski, LP. Factors that influence treatment decision in older patients with resectable head and neck cancer. Laryngoscope 2007;117:835–40
7Goodwin, JS, Hunt, WC, Samet, JM. Determinants of cancer therapy in elderly patients. Cancer 1993;72:594601
8Sharma, A, Madan, R, Kumar, R, Sagar, P, Kamal, VK, Thakar, A et al. Compliance to therapy–elderly head and neck carcinoma patients. Can Geriatr J 2014;17:83–7
9Hutchins, LF, Unger, JM, Crowley, JJ, Coltman, CA Jr, Albain, KS. Underrepresentation of patients 65 years of age or older in cancer-treatment trials. N Engl J Med 1999;341:2061–7
10Balducci, L, Beghe, C. Cancer and age in the USA. Crit Rev Oncol Hematol 2001;37:137–45
11Syrigos, KN, Karapanagiotou, E, Charpidou, A, Dilana, K, Dannos, I, Dionellis, G et al. Biweekly administration of docetaxel and gemcitabine for elderly patients with advanced non-small cell lung cancer: a phase II study. J Chemother 2007;19:438–43
12Parker, SL, Tong, T, Bolden, S, Wingo, PA. Cancer statistics, 1996. CA Cancer J Clin 1996;46:527
13Pallis, AG, Fortpied, C, Wedding, U, Van Nes, MC, Penninckx, B, Ring, A et al. EORTC elderly task force position paper: approach to the older cancer patient. Eur J Cancer 2010;46:1502–13
14Pignon, T, Horiot, JC, Van den Bogaert, W, Van Glabbeke, M, Scalliet, P. No age limit for radical radiotherapy in head and neck tumours. Eur J Cancer 1996;32:2075–81
15Lusinchi, A, Bourhis, J, Wibault, P, Le Ridant, AM, Eschwege, F. Radiation therapy for head and neck cancers in the elderly. Int J Radiat Biol 1990;18:819–23
16Schofield, CP, Sykes, AJ, Slevin, NJ, Rashid, NZ. Radiotherapy for head and neck cancer in elderly patients. Radiother Oncol 2003;69:3742
17Tsukuda, M, Ishitoya, J, Mikami, Y, Matsuda, H, Horiuchi, C, Taguchi, T et al. Analysis of feasibility and toxicity of concurrent chemoradiotherapy with S-1 for locally advanced squamous cell carcinoma of the head and neck in elderly cases and/or cases with comorbidity. Cancer Chemother Pharmacol 2009;64:945–52
18Koussis, H, Scola, A, Bergamo, F, Tonello, S, Basso, U, Karahontzitis, P et al. Neoadjuvant carboplatin and vinorelbine followed by chemoradiotherapy in locally advanced head and neck or oesophageal squamous cell carcinoma: a phase II study in elderly patients or patients with poor performance status. Anticancer Res 2008;28:1383–8
19Nguyen, NP, Vock, J, Chi, A, Vinh-Hung, V, Dutta, S, Ewell, L et al. Impact of intensity-modulated and image-guided radiotherapy on elderly patients undergoing chemoradiation for locally advanced head and neck cancer. Strahlenther Onkol 2012;188:677–85
20Kowalski, LP, Alcantara, PS, Magrin, J, Parise, O Jr. A case-control study on complications and survival in elderly patients undergoing major head and neck surgery. Am J Surg 1994;168:485–90
21Clayman, GL, Eicher, SA, Sicard, MW, Razmpa, E, Goepfert, H. Surgical outcomes in head and neck cancer patients 80 years of age and older. Head Neck 1998;20:216–23
22McGuirt, WF, Davis, SP. Demographic portrayal and outcome analysis of head and neck cancer surgery in the elderly. Arch Otolaryngol Head Neck Surg 1995;121:150–4
23Dripps, RD. New classification of physical status. Anesthesiology 1963;24:111
24Kesting, MR, Hölzle, F, Wolff, KD, Wagenpfeil, S, Hasler, RJ, Wales, CJ et al. Use of microvascular flap technique in older adults with head and neck cancer: a persisting dilemma in reconstructive surgery? J Am Geriatr Soc 2011;59:398405
25Boruk, M, Chernobilsky, B, Rosenfeld, RM, Har-El, G. Age as a prognostic factor for complications of major head and neck surgery. Arch Otolaryngol Head Neck Surg 2005;131:605–9
26Engoren, MC, Arslanian-Engoren, CM. Outcome after tracheostomy for respiratory failure in the elderly. J Intensive Care Med 2005;20:104–10
27Menaker, J, Scalea, TM. Geriatric care in the surgical intensive care unit. Crit Care Med 2010;38:S4529
28Parker, V, Shylan, G, Archer, W, McMullen, P, Smith, K, Giles, M et al. Trends and challenges in the management of tracheostomy in older people: the need for a multidisciplinary team approach. Contemp Nurse 2007;26:177–83
29Roy, N, Stemple, J, Merrill, RM, Thomas, L. Dysphagia in the elderly: preliminary evidence of prevalence, risk factors, and socioemotional effects. Ann Otol Rhinol Laryngol 2007;116:858–65
30Leder, SB, Joe, JK, Ross, DA, Coelho, DH, Mendes, J. Presence of a tracheotomy tube and aspiration status in early, postsurgical head and neck cancer patients. Head Neck 2005;27:757–61
31Garuti, G, Reverberi, C, Briganti, A, Massobrio, M, Lombardi, F, Lusuardi, M. Swallowing disorders in tracheostomised patients: a multidisciplinary/multiprofessional approach in decannulation protocols. Multidiscip Respir Med 2014;9:36
32Brathwaite, D, Weissman, C. The new onset of atrial arrhythmias following major noncardiothoracic surgery is associated with increased mortality. Chest 1998;114:462–8

Keywords

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed