Surgical outcomes in head and neck cancer patients 80 years of age and older

BACKGROUND: Elderly patients over 80 years of age represent a growing population, some of whom have complex medical problems that are compounded by the presence of upper aerodigestive tract cancer. METHODS: Forty-three patients, aged 80 years and older, who were initially seen with head and neck squamous cell carcinoma from 1986 to 1992 at a tertiary-care center were compared with 79 similar patients, aged 65 years or younger, in a retrospective, case-control study. RESULTS: Median overall survival for the patients over 80 years of age was significantly lower than that for the controls (p = .001). However, their overall survival was similar to the actuarial survival for the general octogenarian population. Advanced age also adversely affected local control (p < .001) and disease-specific survival (p = .041). Although the older age group had a higher frequency of morbid preoperative conditions, there were no significant differences in perioperative or postoperative complications between the two groups. CONCLUSIONS: Careful preoperative staging and evaluation of associated medical illnesses, as well as skillful perioperative and postoperative management, are essential for reducing operative morbidity and mortality in the octogenarian patient. Successful outcome depends upon appropriate surgical management, treatment of concurrent illnesses, and minimization of postoperative complications. Individualized surgical management of the elderly head and neck cancer patient is effective, well tolerated, and clinically indicated for upper aerodigestive tract malignancies.