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Ozbek L, Lion P, Patel A, Hughes J, Shah K, Stimpson P. Laryngectomy in Elderly Patients: A Case Series and Review of the Literature. Cureus 2023; 15:e49294. [PMID: 38957195 PMCID: PMC11218606 DOI: 10.7759/cureus.49294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2023] [Indexed: 07/04/2024] Open
Abstract
Background and objective Patients over the age of 75 years make up 20% of the head and neck cancer population, which is a relatively under-represented patient cohort in clinical literature. To our knowledge, there are no studies evaluating the outcomes of laryngectomy in patients aged over 75 years, which prompted us to present this unique series. Methods We reviewed departmental records at the University College Hospital, London over a 10-year period, and identified a total of 18 patients over the age of 75 years who underwent total laryngectomy for squamous cell carcinoma. We evaluated the demographic, clinical, and histopathologic features and outcomes for each patient. Results The age of the cohort ranged from 75 to 90 years, with a mean age of 79.8 years. All patients had a Charlson Comorbidity Index (CCI) score of 3 or more (due to age), with a mean of 4.7, and a maximum score of 8 for two patients. Length of inpatient stay varied significantly, ranging from 20 to 149 days, with a mean of 46 days. We identified 14 patients who underwent laryngectomy prior to September 2017, in whom the five-year survival was 21.4%. The three-year survival rate for all patients was 22.2%. In bivariate analysis, advanced age at surgery positively correlated with increased length of hospital admission and increased incidence of complications, although these results were not statistically significant (p<0.05). Conclusions Our study highlights the significance of the impact of age and comorbidities on postoperative outcomes and sheds light on the unique challenges faced by an ageing population. Careful consideration must be made in terms of appropriate patient selection, and clinicians must offer a robust and tailored approach to elderly care.
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Affiliation(s)
- Leyla Ozbek
- Otolaryngology, University College Hospital, London, GBR
| | - Peter Lion
- Otolaryngology, University College Hospital, London, GBR
| | - Ankit Patel
- Otolaryngology, University College Hospital, London, GBR
| | - Jonathan Hughes
- Head and Neck Surgery, University College Hospital, London, GBR
| | - Kuntal Shah
- Head and Neck Surgery, University College Hospital, London, GBR
| | - Paul Stimpson
- Head and Neck Surgery, University College Hospital, London, GBR
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Corsalini M, Barile G, Catapano S, Ciocia A, Casorelli A, Siciliani R, Di Venere D, Capodiferro S. Obturator Prosthesis Rehabilitation after Maxillectomy: Functional and Aesthetical Analysis in 25 Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312524. [PMID: 34886250 PMCID: PMC8657009 DOI: 10.3390/ijerph182312524] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/23/2021] [Accepted: 11/25/2021] [Indexed: 11/30/2022]
Abstract
The number of patients undergoing a surgical resection of the maxilla for oncological reasons is constantly increasing, the most common complication of which remains the communication between oral and nasal cavities. On the basis of data arising from the literature regarding the treatment options of maxillary oncological post-surgical defects, obturator prosthesis remains the most used worldwide. We studied 25 patients (with at least 1-year follow up) rehabilitated by obturator prosthesis after maxillary resection leading to oro-nasal communication, providing data on the objective/subjective evaluation of such rehabilitation and mastication performance measured by a two-color chewing gum test. The type of defect was classified according to the classification system proposed by Aramany. Among the patients in our study, 72% rated a higher score for either stability and retention than for aesthetic appearance, as confirmed by the Kapur score rated by clinicians. The two-color chewing gum test shows similar results as only one patient had insufficient chewing function. Interestingly, we found no correlation between the masticatory function and residual denture, confirming that the maxillary obturator remains a predictable solution in such patients regardless of the anatomical alterations following surgery.
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Affiliation(s)
- Massimo Corsalini
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (G.B.); (A.C.); (A.C.); (R.S.); (D.D.V.)
- Correspondence: (M.C.); (S.C.)
| | - Giuseppe Barile
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (G.B.); (A.C.); (A.C.); (R.S.); (D.D.V.)
| | - Santo Catapano
- Dental Clinic, Dental School, University of Ferrara, 44121 Ferrara, Italy;
| | - Annamaria Ciocia
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (G.B.); (A.C.); (A.C.); (R.S.); (D.D.V.)
| | - Assunta Casorelli
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (G.B.); (A.C.); (A.C.); (R.S.); (D.D.V.)
| | - Rosaria Siciliani
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (G.B.); (A.C.); (A.C.); (R.S.); (D.D.V.)
| | - Daniela Di Venere
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (G.B.); (A.C.); (A.C.); (R.S.); (D.D.V.)
| | - Saverio Capodiferro
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, 70124 Bari, Italy; (G.B.); (A.C.); (A.C.); (R.S.); (D.D.V.)
- Correspondence: (M.C.); (S.C.)
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Jung AR, Roh JL, Kim JS, Choi SH, Nam SY, Kim SY. The impact of skeletal muscle depletion on older adult patients with head and neck cancer undergoing primary surgery. J Geriatr Oncol 2021; 12:128-133. [PMID: 32565144 DOI: 10.1016/j.jgo.2020.06.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 04/27/2020] [Accepted: 06/03/2020] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Sarcopenia may result in negative outcomes in patients with cancer, but its impact on surgical and oncological outcomes in older adult patients with head and neck squamous cell carcinoma (HNSCC) has not been systematically studied. This study evaluated the clinical impact of sarcopenia on postsurgical and oncological outcomes in older adult patients with HNSCC. METHODS This is a prospective study of 190 consecutive HNSCC patients aged ≥65 years who underwent curative surgery at a tertiary referral hospital. Sarcopenia was determined from measurement of the cross-sectional area of skeletal muscles at the level of the third lumbar vertebra on pretreatment images of whole body 18F-fluorodeoxyglucose positron emission tomography/computed tomography. Primary outcomes were early complications and overall survival. Factors of early complications and readmission were identified using binary logistic regression analyses, and factors of overall survival and disease-free survival were identified using univariate and multivariate Cox proportional hazards regression analyses. RESULTS Pretreatment sarcopenia were found in 64 (33.7%) patients. In multivariate analysis, sarcopenia and N classification were significantly associated with early complications, while sarcopenia and T classification were associated with readmission. Independent factors of overall survival outcomes were age, sarcopenia, and extranodal extension (all P < .005). Sarcopenia was also an independent factor predictive of disease-free survival outcome (P < .001). Sarcopenia was associated with a 3.2-fold increase in the early complication rate and 4.5-fold increase in mortality in older adult surgical patients with HNSCC. CONCLUSION Sarcopenia may predict early complications and survival after curative surgery in older adult patients with HNSCC.
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Affiliation(s)
- Ah Ra Jung
- Departments of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea; Department of Otorhinolaryngology-Head and Neck Surgery, Eulji Medical Center, Eulji University School of Medicine, Seoul, Republic of Korea
| | - Jong-Lyel Roh
- Department of Otorhinolaryngology-Head and Neck Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea.
| | - Jae Seung Kim
- Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seung-Ho Choi
- Departments of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Soon Yuhl Nam
- Departments of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sang Yoon Kim
- Departments of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Taberna M, Gil Moncayo F, Jané-Salas E, Antonio M, Arribas L, Vilajosana E, Peralvez Torres E, Mesía R. The Multidisciplinary Team (MDT) Approach and Quality of Care. Front Oncol 2020; 10:85. [PMID: 32266126 PMCID: PMC7100151 DOI: 10.3389/fonc.2020.00085] [Citation(s) in RCA: 139] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 01/16/2020] [Indexed: 12/17/2022] Open
Abstract
The core function of a multidisciplinary team (MDT) is to bring together a group of healthcare professionals from different fields in order to determine patients' treatment plan. Most of head and neck cancer (HNC) units are currently led by MDTs that at least include ENT and maxillofacial surgeons, radiation and medical oncologists. HNC often compromise relevant structures of the upper aerodigestive tract involving functions such as speech, swallowing and breathing, among others. The impairment of these functions can significantly impact patients' quality of life and psychosocial status, and highlights the crucial role of specialized nurses, dietitians, psycho-oncologists, social workers, and onco-geriatricians, among others. Hence, these professionals should be integrated in HNC MDTs. In addition, involving translational research teams should also be considered, as it will help reducing the existing gap between basic research and the daily clinical practice. The aim of this comprehensive review is to assess the role of the different supportive disciplines integrated in an MDT and how they help providing a better care to HNC patients during diagnosis, treatment and follow up.
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Affiliation(s)
- Miren Taberna
- Medical Oncology Department, Catalan Institute of Oncology (ICO), ONCOBELL, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Francisco Gil Moncayo
- Psicooncology Department, Catalan Institute of Oncology (ICO), IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Enric Jané-Salas
- Department of Odontostomatology, Faculty of Medicine and Health Sciences (Dentistry), University of Barcelona, Barcelona, Spain.,Oral Health and Masticatory System Group (Bellvitge Biomedical Research Institute) IDIBELL, L'Hospitalet de Llobregat, University of Barcelona, Barcelona, Spain
| | - Maite Antonio
- Oncogeriatrics Unit, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Lorena Arribas
- Clinical Nutrition Unit, Catalan Institute of Oncology (ICO), IDIBELL, L'Hospitalet de Llobregat, University of Barcelona, Barcelona, Spain
| | - Esther Vilajosana
- Head and Neck Nurse, Head and Neck Functional Unit, Catalan Institute of Oncology (ICO), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Elisabet Peralvez Torres
- Expert SLP in Oncologic Patients, Head of SLP's Department, Atos Medical Spain, Barcelona, Spain
| | - Ricard Mesía
- Medical Oncology Department, Catalan Institute of Oncology (ICO), B-ARGO, Barcelona, Spain
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Falk AT, Hébert C, Tran A, Chand ME, Leysalle A, Thariat J, Dassonville O, Poissonnet G, Bozec A, Saada E, Peyrade F, Benezery K. Radiotherapy for elderly patients and cetuximab, a monocentric study. Eur Arch Otorhinolaryngol 2016; 274:1061-1065. [DOI: 10.1007/s00405-016-4336-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 10/04/2016] [Indexed: 12/16/2022]
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Socioeconomic Considerations and Shared-Care Models of Cancer Care for Older Adults. Clin Geriatr Med 2016; 32:35-44. [DOI: 10.1016/j.cger.2015.08.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Pottel L, Lycke M, Boterberg T, Pottel H, Goethals L, Duprez F, Rottey S, Lievens Y, Van Den Noortgate N, Geldhof K, Buyse V, Kargar-Samani K, Ghekiere V, Debruyne PR. G-8 indicates overall and quality-adjusted survival in older head and neck cancer patients treated with curative radiochemotherapy. BMC Cancer 2015; 15:875. [PMID: 26553007 PMCID: PMC4640221 DOI: 10.1186/s12885-015-1800-1] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 10/16/2015] [Indexed: 12/12/2022] Open
Abstract
Background Evidence-based guidelines concerning the older head and neck cancer (HNCA) patient are lacking. Accurate patient selection for optimal care management is therefore challenging. We examined if geriatric assessment is indicative of long-term health-related quality of life (HRQOL) and overall survival in this unique population. Methods All HNCA patients, aged ≥65 years, eligible for curative radio(chemo)therapy were evaluated with the Geriatric-8 (G-8) questionnaire and a comprehensive geriatric assessment (CGA). Euroqol-5 dimensions (EQ-5D) and survival were collected until 36 months post treatment start. Repeated measures ANOVA was applied to analyse HRQOL evolution in ‘fit’ and ‘vulnerable’ patients, defined by G-8. Kaplan-Meier curves and cox proportional hazard analysis were established for determination of the prognostic value of geriatric assessments. Quality-adjusted survival was calculated in both patient subgroups. Results One hundred patients were recruited. Seventy-two percent of patients were considered vulnerable according to CGA (≥2 abnormal tests). Fit patients maintained a relatively acceptable long-term HRQOL, whilst vulnerable patients showed significantly lower median health states. The difference remained apparent at 36 months. Vulnerability, as classified by G-8 or CGA, came forward as independent predictor for lower EQ-5D index scores. After consideration of confounders, a significantly lower survival was observed in patients defined vulnerable according to G-8, compared to fit patients. A similar trend was seen based on CGA. Calculation of quality-adjusted survival showed significantly less remaining life months in perfect health in vulnerable patients, compared to fit ones. Conclusions G-8 is indicative of quality-adjusted survival, and should be considered at time of treatment decisions for the older HNCA patient. Electronic supplementary material The online version of this article (doi:10.1186/s12885-015-1800-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lies Pottel
- Kortrijk Cancer Centre, General Hospital Groeninge, campus loofstraat, Cancer Centre, Loofstraat 43, B-8500, Kortrijk, Belgium.
| | - Michelle Lycke
- Kortrijk Cancer Centre, General Hospital Groeninge, campus loofstraat, Cancer Centre, Loofstraat 43, B-8500, Kortrijk, Belgium.
| | - Tom Boterberg
- Department of Radiation Oncology, Ghent University Hospital, De Pintelaan 185, B-9000, Ghent, Belgium.
| | - Hans Pottel
- Department of Public Health and Primary Care, Subfaculty of Medicine, Catholic University Leuven Kulak, Etienne Sabbelaan 53, B-8500, Kortrijk, Belgium.
| | - Laurence Goethals
- Kortrijk Cancer Centre, General Hospital Groeninge, campus loofstraat, Cancer Centre, Loofstraat 43, B-8500, Kortrijk, Belgium.
| | - Fréderic Duprez
- Department of Radiation Oncology, Ghent University Hospital, De Pintelaan 185, B-9000, Ghent, Belgium.
| | - Sylvie Rottey
- Department of Medical Oncology, Ghent University Hospital, De Pintelaan 185, B-9000, Ghent, Belgium.
| | - Yolande Lievens
- Department of Radiation Oncology, Ghent University Hospital, De Pintelaan 185, B-9000, Ghent, Belgium.
| | - Nele Van Den Noortgate
- Department of Geriatrics, Ghent University Hospital, De Pintelaan 185, B-9000, Ghent, Belgium.
| | - Kurt Geldhof
- Department of Internal Medicine, Jan Yperman Hospital, Briekestraat 12, B-8900, Ypres, Belgium.
| | - Véronique Buyse
- Department of Internal Medicine, General Hospital OLV Lourdes, Vijfseweg 150, B-8790, Waregem, Belgium.
| | - Khalil Kargar-Samani
- Department of Oncology, Centre Hospitalier de Wallonie Picarde, RHMS, Chaussée de Saint-Amand 80, B-7500, Tournai, Belgium.
| | - Véronique Ghekiere
- Department of Geriatrics, General Hospital Groeninge, Reepkaai 4, B-8500, Kortrijk, Belgium.
| | - Philip R Debruyne
- Kortrijk Cancer Centre, General Hospital Groeninge, campus loofstraat, Cancer Centre, Loofstraat 43, B-8500, Kortrijk, Belgium. .,Ageing & Cancer Research Cluster, Centre for Positive Ageing, University of Greenwich, Avery Hill Rd., SE9 2UG, Eltham, London, UK.
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Early glottic cancer: role of MRI in the preoperative staging. BIOMED RESEARCH INTERNATIONAL 2014; 2014:890385. [PMID: 25197667 PMCID: PMC4150401 DOI: 10.1155/2014/890385] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Revised: 07/12/2014] [Accepted: 07/23/2014] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Clinical staging is the most important time in management of glottic cancer in early stage (I-II). We have conducted a prospective study to evaluate if magnetic resonance imaging (MRI) is more accurate than computed tomography (CT) about tumoral extension, to exactly choose the most appropriate surgical approach, from organ preservation surgery to demolitive surgery. MATERIALS and METHODS This prospective study was conducted on 26 male patients, with suspected laryngeal neoplasia of glottic region. The images of MRI and CT were analyzed to define the expansion of glottic lesion to anterior commissure, laryngeal cartilages, subglottic and/or supraglottic site, and paraglottic space. The results of MRI and CT were compared with each other and with the pathology report. RESULTS CT accuracy was 70% with low sensitivity but with high specific value. MRI showed a diagnostic accuracy in 80% of cases, with a sensitivity of 100% and high specificity. Statistical analysis showed that MRI has higher correlation than CT with the pathology report. CONCLUSION Our study showed that MRI is more sensitive than CT in the preoperative staging of early glottic cancer, to select exactly the eligible patients in conservative surgery of the larynx, as supracricoid laryngectomy and cordectomy by CO2 laser.
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Gerude MF, Dias FL, de Farias TP, Albuquerque Sousa B, Thuler LCS. Predictors of Postoperative Complications, Prolonged Length of Hospital Stay, and Short-Term Mortality in Elderly Patients with Malignant Head and Neck Neoplasm. ORL J Otorhinolaryngol Relat Spec 2014; 76:153-64. [DOI: 10.1159/000363189] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 04/24/2014] [Indexed: 11/19/2022]
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Genther DJ, Gourin CG. Effect of comorbidity on short-term outcomes and cost of care after head and neck cancer surgery in the elderly. Head Neck 2014; 37:685-93. [PMID: 24596299 DOI: 10.1002/hed.23651] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 02/18/2014] [Accepted: 03/01/2014] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND With increased life expectancy, there is growing awareness of the effect of comorbidity on physiologic reserves in elderly patients. Data in the area of head and neck cancer surgery is lacking. METHODS Retrospective data from 61,740 elderly patients who underwent a head and neck cancer ablative surgery from 2001 to 2010 using the Nationwide Inpatient Sample were analyzed to examine associations between comorbidity and in-hospital mortality, postoperative complications, length of hospitalization, and hospital-related costs. RESULTS Advanced comorbidity was present in 18% of elderly patients, who were more likely to experience acute medical complications (odds ratio [OR], 3.7; p < .001), in-hospital death (OR, 3.6; p < .001), increased length of hospitalization (mean, 2.2 days; p < .001), and hospital-related costs (mean, $6874; p < .001). CONCLUSION Advanced comorbidity in elderly surgical patients with head and neck cancer is associated with increased mortality, morbidity, length of hospitalization, and hospital-related costs. This increased utilization of health care resources may pose challenges to health care reform efforts as the population ages.
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Affiliation(s)
- Dane J Genther
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland
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Radiotherapy for head and neck cancer in nonagenarian patients: a possible cornerstone? Eur Arch Otorhinolaryngol 2014; 272:719-25. [DOI: 10.1007/s00405-014-3017-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Accepted: 03/18/2014] [Indexed: 11/25/2022]
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12
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Sarris EG, Harrington KJ, Saif MW, Syrigos KN. Multimodal treatment strategies for elderly patients with head and neck cancer. Cancer Treat Rev 2014; 40:465-75. [DOI: 10.1016/j.ctrv.2013.10.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Revised: 10/06/2013] [Accepted: 10/18/2013] [Indexed: 12/15/2022]
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Monroe MM, Myers JN, Kupferman ME. Undertreatment of thick head and neck melanomas: an age-based analysis. Ann Surg Oncol 2013; 20:4362-9. [PMID: 23975303 DOI: 10.1245/s10434-013-3160-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Indexed: 02/03/2023]
Abstract
PURPOSE To determine U.S. treatment patterns for pathologic staging practices in patients with thick head and neck melanomas (HNM). METHODS Patients with thick HNM without clinical evidence of in-transit, regional, or distant metastatic spread at presentation were identified from the Surveillance Epidemiology and End Results database. Treatment trends for patients were summarized, and univariate and multivariate analyses were performed to identify associations between varying practice patterns. RESULTS A total of 1,230 patients with HNM meeting the inclusion criteria were identified. Surgical staging procedures were utilized in 53.5 %, including both sentinel lymph node biopsy (37 %) and elective neck dissection (16 %). Patients undergoing a surgical staging procedure were younger (64 vs. 77 years, p < 0.001) with smaller tumors (6.3 vs. 6.6 mm, p = 0.008). The rate of occult nodal disease was 22 % in patients undergoing a surgical staging procedure. The presence of a positive regional node in this subgroup of patients was associated with a significant reduction in disease-specific (44 vs. 59 months, p < 0.001) and overall survival (40 vs. 53 months, p < 0.001) on univariate analysis. On multivariate analysis, the presence of a positive node was the most significant factor for reduced overall survival (hazard ratio 2.36, 95 % confidence interval 1.71-3.23) and disease-specific survival (hazard ratio 2.84, 95 % confidence interval 1.99-4.06). CONCLUSIONS Pathologic staging procedures provide independent prognostic information for patients with thick HNM. Despite this, current practice patterns demonstrate underutilization, particularly in elderly patients. Further work is needed to address the barriers to pathologic staging implementation in patients with thick HNM.
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Affiliation(s)
- Marcus M Monroe
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA,
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Lagier A, Mimouni-Benabu O, Baumstarck K, Boulogne O, Michel J, Benabu D, Dessi P, Giovanni A, Fakhry N. The influence of age on postoperative complications after total laryngectomy or pharyngolaryngectomy. Eur J Surg Oncol 2013; 40:202-7. [PMID: 24071365 DOI: 10.1016/j.ejso.2013.09.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 08/19/2013] [Accepted: 09/06/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE This study aimed to evaluate the role of age in the occurrence of postoperative complications after total laryngopharyngectomy (TLP) or total laryngectomy (TL). MATERIALS AND METHODS This was a retrospective study including all patients who underwent TLP or TL in our institution between January 2005 and December 2010. The impact of age (greater than 65 years), history of cancer treatments and comorbidities on early postoperative course was analyzed using univariate and multivariate analyses. RESULTS Out of the 97 patients operated on, 21% had cancer of the hypopharynx and 79% of the larynx. Mean age at surgery was 63 years (41-90 years). 44% of patients were more than or equal to 65 years of age. Regarding local complications, only age (p = 0.004) had a statistically significant influence in univariate analysis. In multivariate analysis, age (OR 21.4, p = 0.0001) and alcohol consumption (OR 0.18, p = 0.04) were significant. Factors influencing the occurrence of general complications were, in univariate analysis: age >65 years (p = 0.003), type of surgery (p = 0.042), the presence of cardiovascular history (p = 0.47) and ASA score >2 (p = 0.007). In multivariate analysis, only age >65 years remained significant (OR 3.31, p = 0.013). CONCLUSION Our results highlight the importance of preoperative oncogeriatric evaluation from the age of 65 years to optimize surgical management.
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Affiliation(s)
- A Lagier
- Service d'ORL et Chirurgie Cervico-Faciale, Centre Hospitalier Universitaire La Timone, 264 rue Saint Pierre, 13385 Marseille Cedex 05, France
| | - O Mimouni-Benabu
- Service d'ORL et Chirurgie Cervico-Faciale, Centre Hospitalier Universitaire La Timone, 264 rue Saint Pierre, 13385 Marseille Cedex 05, France
| | - K Baumstarck
- Unité d'Aide Méthodologique à la Recherche Clinique, Assistance Publique - Hôpitaux de Marseille, Centre Hospitalier Universitaire La Timone, 264 rue Saint Pierre, 13385 Marseille Cedex 05, France; EA 3279 'Qualité de Vie Concepts, Usages et Limites, Déterminants' Aix-Marseille Université, Faculté de Médecine, 27 bd Jean Moulin, 13385 Marseille Cedex 05, France
| | - O Boulogne
- EA 3279 'Qualité de Vie Concepts, Usages et Limites, Déterminants' Aix-Marseille Université, Faculté de Médecine, 27 bd Jean Moulin, 13385 Marseille Cedex 05, France
| | - J Michel
- Service d'ORL et Chirurgie Cervico-Faciale, Centre Hospitalier Universitaire La Timone, 264 rue Saint Pierre, 13385 Marseille Cedex 05, France
| | - D Benabu
- Service d'ORL et Chirurgie Cervico-Faciale, Centre Hospitalier Universitaire La Timone, 264 rue Saint Pierre, 13385 Marseille Cedex 05, France
| | - P Dessi
- Service d'ORL et Chirurgie Cervico-Faciale, Centre Hospitalier Universitaire La Timone, 264 rue Saint Pierre, 13385 Marseille Cedex 05, France
| | - A Giovanni
- Service d'ORL et Chirurgie Cervico-Faciale, Centre Hospitalier Universitaire La Timone, 264 rue Saint Pierre, 13385 Marseille Cedex 05, France
| | - N Fakhry
- Service d'ORL et Chirurgie Cervico-Faciale, Centre Hospitalier Universitaire La Timone, 264 rue Saint Pierre, 13385 Marseille Cedex 05, France.
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VanderWalde NA, Fleming M, Weiss J, Chera BS. Treatment of older patients with head and neck cancer: a review. Oncologist 2013; 18:568-78. [PMID: 23635557 DOI: 10.1634/theoncologist.2012-0427] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The incidence of head and neck cancer (HNC) in the elderly is increasing. The treatment of HNC often includes multimodality therapy that can be quite morbid. Older patients (herein, defined as ≥65 years) with HNC often have significant comorbidity and impaired functional status that may hinder their ability to receive and tolerate combined modality therapy. They have often been excluded from clinical trials that have defined standards of care. Therefore, tailoring cancer therapy for older patients with HNC can be quite challenging. In this paper, we performed a comprehensive literature review to better understand and discuss issues related to therapeutic recommendations that are particular to patients 65 years and older. Evidence suggests that older patients have similar survival outcomes compared with their younger peers; however, they may experience worse toxicity, especially with treatment intensification. Similarly, older patients may require more supportive care throughout the treatment process. Future studies incorporating geriatric tools for predictive and interventional purposes will potentially allow for improved patient selection and tolerance to intensive treatment.
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Affiliation(s)
- Noam A VanderWalde
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27514, USA
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Current world literature. Curr Opin Otolaryngol Head Neck Surg 2012; 20:148-51. [PMID: 22555614 DOI: 10.1097/moo.0b013e328351a36c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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