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 compou nded by the presence of upper aerodigestive tract cancer. Methods. For ty-three patients, aged 80 years and older, who were initially seen wi th head and neck squamous cell carcinoma from 1986 to 1992 at a tertia ry-care center were compared with 79 similar patients, aged 65 years o r younger, in a retrospective, case-control study. Results. Median ove rall survival for the patients over 80 years of age was significantly lower than that for the controls (p = .001). However, their overall su rvival was similar to the actuarial survival for the general octogenar ian 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 com plications between the two groups. Conclusions. Careful preoperative s taging and evaluation of associated medical illnesses, as well as skil lful perioperative and postoperative management, are essential for red ucing operative morbidity and mortality in the octogenarian patient. S uccessful outcome depends upon appropriate surgical management, treatm ent of concurrent illnesses, and minimization of postoperative complic ations. Individualized surgical management of the elderly head and nec k cancer patient is effective, well tolerated, and clinically indicate d for upper aerodigestive tract malignancies. (C) 1998 John Wiley & So ns, Inc.