Microsurgical Reconstructions for Head and Neck Cancers in Elderly Aged >80 Years: An Analysis of Surgical Outcomes and Quality of Life

• Published in: Annals of surgical oncology 2016-05, Vol.23 (5), p.1684-1692
• Main Authors: Dimovska, E. O. F., Clibbon, J. J., Moncrieff, M. D. S., Heaton, M. J., Figus, A.
• Format: Article
• Language: English
• Subjects: Aged, 80 and over; Female; Follow-Up Studies; Head and Neck Neoplasms - pathology; Head and Neck Neoplasms - surgery; Head and Neck Oncology; Humans; Male; Medicine; Medicine & Public Health; Microsurgery; Neoplasm Grading; Neoplasm Staging; Oncology; Prognosis; Quality of Life; Reconstructive Surgical Procedures - methods; Retrospective Studies; Surgery; Surgical Oncology; Survival Rate
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-015-5049-3

Background The rising incidence of primary head and neck (H&N) cancers in the elderly presents a dilemma regarding the appropriateness of complex surgery in this assumed frail age group. With limited data on surgical morbidity, survival, and patient quality of life (QOL), this analysis aimed to broaden the understanding of safety and effectiveness of microsurgical treatment in very elderly H&N cancer patients. Methods A prospective database analysis was used to evaluate surgical outcomes (morbidity, survival, and QOL) in all patients aged 80 years and older undergoing microsurgical reconstruction for cutaneous and intra-oral H&N cancers between 2004 and 2014. Outcomes were assessed for their association with surgical, tumour, and patient variables. Comorbidities were categorized by the ACE27 index and postoperative morbidity by the Clavien–Dindo scoring system. QOL was analyzed using the UW-QOLv4. Results Of 720 microsurgical reconstructions, 96 patients were identified. Median survival was 25 months. The ACE27 index was the only variable significantly associated with survival with a 5-year survival of 59.2 % in the least comorbid group versus 19.7 % in the most comorbid group ( p 0.015). ACE-27 showed influence on socioemotional QoL scores. Physical QOL scores were influenced by tumour and operative factors. Patients were found to value physical QOL over socioemotional. Conclusions Microsurgical reconstructions are well tolerated in the very elderly patients and should be considered predominantly based on comorbidity. Tumour stage, flap type, and cancer site should still form part of the preoperative counseling due to their implication on postoperative physical function.