Evaluation of the Relationship between Age and Outcome after Microvascular Reconstruction among Patients with Recurrent Head and Neck Squamous Cell Carcinoma

Abstract

Background In patients with head and neck squamous cell carcinoma (HNSCC), disease recurrence remains a significant obstacle to long-term survival. If possible, surgical salvage with reconstruction remains the best treatment option for patients with recurrence. Currently, there is no literature discussing whether age should preclude microvascular reconstruction in these patients. We hypothesize that older age alone does not affect outcomes.

Methods A retrospective chart review of patients with HNSCC at our institution between 2008 and 2015 was performed. Patients were included if they underwent simultaneous resection and flap reconstruction for recurrent HNSCC. Data collected included age, sex, primary site, type of reconstruction, previous treatments, postoperative complications (systemic and reconstructive), and overall survival.

Results A total of 65 patients met inclusion criteria for the review: 42 (64.6%) patients ≤70 years and 23 (35.4%) patients > 70 years. Overall survival was not significantly different between the younger and older groups (p = 0.199). Five-year survival was 60.1% in the younger group and 46.8% in the older group. No significant difference was found in reconstructive complication rates (p = 0.179) or systemic complication rates (p = 0.241) between the two groups. Multivariate logistic regression analysis further showed no significant association between patients' age (≤70 years or > 70 years) and reconstructive complications (p = 0.396) or systemic complications (p = 0.119).

Conclusion Age is not significantly associated with complications among patients undergoing resection and reconstruction for recurrent HNSCC. Microvascular reconstruction remains a feasible option in older patients with recurrent HNSCC. Advanced age alone should not preclude the surgical management of recurrent HNSCC.

Keywords

head and neck cancer - squamous cell carcinoma of the head and neck - free tissue flaps - microsurgical free flaps - reconstructive surgical procedures - palliative surgery - life expectancy

• References

• 1 Siegel R, Ma J, Zou Z, Jemal A. Cancer statistics, 2014. CA Cancer J Clin 2014; 64 (1) 9-29
• 2 DeSantis CE, Lin CC, Mariotto AB , et al. Cancer treatment and survivorship statistics, 2014. CA Cancer J Clin 2014; 64 (4) 252-271
• 3 Marur S, Forastiere AA. Head and neck cancer: changing epidemiology, diagnosis, and treatment. Mayo Clin Proc 2008; 83 (4) 489-501
• 4 Cooper JS, Pajak TF, Forastiere AA , et al; Radiation Therapy Oncology Group 9501/Intergroup. Postoperative concurrent radiotherapy and chemotherapy for high-risk squamous-cell carcinoma of the head and neck. N Engl J Med 2004; 350 (19) 1937-1944
• 5 Bernier J, Domenge C, Ozsahin M , et al; European Organization for Research and Treatment of Cancer Trial 22931. Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer. N Engl J Med 2004; 350 (19) 1945-1952
• 6 Yang R, Lubek JE, Dyalram D, Liu X, Ord RA. Head and neck cancer surgery in an elderly patient population: a retrospective review. Int J Oral Maxillofac Surg 2014; 43 (12) 1413-1417
• 7 Ferrari S, Copelli C, Bianchi B , et al. Free flaps in elderly patients: outcomes and complications in head and neck reconstruction after oncological resection. J Craniomaxillofac Surg 2013; 41 (2) 167-171
• 8 Ho AS, Kraus DH, Ganly I, Lee NY, Shah JP, Morris LG. Decision making in the management of recurrent head and neck cancer. Head Neck 2014; 36 (1) 144-151
• 9 Goodwin Jr WJ. Salvage surgery for patients with recurrent squamous cell carcinoma of the upper aerodigestive tract: when do the ends justify the means?. Laryngoscope 2000; 110 (3 Pt 2, Suppl 93): 1-18
• 10 Kim J, Kim S, Albergotti WG , et al. Selection of ideal candidates for surgical salvage of head and neck squamous cell carcinoma: effect of the Charlson-age comorbidity index and oncologic characteristics on 1-year survival and hospital course. JAMA Otolaryngol Head Neck Surg 2015; 141 (12) 1059-1065
• 11 Sarris EG, Harrington KJ, Saif MW, Syrigos KN. Multimodal treatment strategies for elderly patients with head and neck cancer. Cancer Treat Rev 2014; 40 (3) 465-475
• 12 Peters TT, Post SF, van Dijk BA , et al. Free flap reconstruction for head and neck cancer can be safely performed in both young and elderly patients after careful patient selection. Eur Arch Otorhinolaryngol 2015; 272 (10) 2999-3005
• 13 Derks W, de Leeuw JR, Hordijk GJ, Winnubst JA. Reasons for non-standard treatment in elderly patients with advanced head and neck cancer. Eur Arch Otorhinolaryngol 2005; 262 (1) 21-26
• 14 Spyropoulou GA, Jeng SF, Hsieh CH, Tsimponis A, Shih HS. Microsurgical reconstruction for head and neck cancer in elderly patients. J Reconstr Microsurg 2014; 30 (2) 91-96
• 15 Weaver TS, Wester JL, Gleysteen JP, Peck JJ, Wax MK. Surgical outcomes in the elderly patient after osteocutaneous free flap transfer. Laryngoscope 2014; 124 (11) 2484-2488
• 16 Sanabria A, Carvalho AL, Melo RL , et al. Predictive factors for complications in elderly patients who underwent head and neck oncologic surgery. Head Neck 2008; 30 (2) 170-177
• 17 Shaari CM, Buchbinder D, Costantino PD, Lawson W, Biller HF, Urken ML. Complications of microvascular head and neck surgery in the elderly. Arch Otolaryngol Head Neck Surg 1998; 124 (4) 407-411
• 18 Boruk 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 (7) 605-609
• 19 Audisio RA, Pope D, Ramesh HS , et al; PACE participants. Shall we operate? Preoperative assessment in elderly cancer patients (PACE) can help. A SIOG surgical task force prospective study. Crit Rev Oncol Hematol 2008; 65 (2) 156-163
• 20 Rodrigo JP, Kowalski LP, Silver CE , et al. When is reoperative surgery not indicated for recurrent head and neck squamous cell carcinoma?. Eur Arch Otorhinolaryngol 2015; 272 (2) 259-262
• 21 Bernardi D, Barzan L, Franchin G , et al. Treatment of head and neck cancer in elderly patients: state of the art and guidelines. Crit Rev Oncol Hematol 2005; 53 (1) 71-80
• 22 Shuman AG, Korc-Grodzicki B, Shklar V, Palmer F, Shah JP, Patel SG. A new care paradigm in geriatric head and neck surgical oncology. J Surg Oncol 2013; 108 (3) 187-191
• 23 Sarini J, Fournier C, Lefebvre JL, Bonafos G, Van JT, Coche-Dequéant B. Head and neck squamous cell carcinoma in elderly patients: a long-term retrospective review of 273 cases. Arch Otolaryngol Head Neck Surg 2001; 127 (9) 1089-1092
• 24 Jun MY, Strong EW, Saltzman EI, Gerold FP. Head and neck cancer in the elderly. Head Neck Surg 1983; 5 (5) 376-382
• 25 Kim AJ, Suh JD, Sercarz JA , et al. Salvage surgery with free flap reconstruction: factors affecting outcome after treatment of recurrent head and neck squamous carcinoma. Laryngoscope 2007; 117 (6) 1019-1023
• 26 Shestak KC, Jones NF, Wu W, Johnson JT, Myers EN. Effect of advanced age and medical disease on the outcome of microvascular reconstruction for head and neck defects. Head Neck 1992; 14 (1) 14-18
• 27 McMahon JD, MacIver C, Smith M , et al. Postoperative complications after major head and neck surgery with free flap repair—prevalence, patterns, and determinants: a prospective cohort study. Br J Oral Maxillofac Surg 2013; 51 (8) 689-695
• 28 Bhama PK, Patel SA, Khan U, Bhrany AD, Futran ND. Head and neck free flap reconstruction in patients older than 80 years. J Reconstr Microsurg 2014; 30 (8) 523-530
• 29 Wester JL, Lindau RH, Wax MK. Efficacy of free flap reconstruction of the head and neck in patients 90 years and older. JAMA Otolaryngol Head Neck Surg 2013; 139 (1) 49-53
• 30 Strojan P, Corry J, Eisbruch A , et al. Recurrent and second primary squamous cell carcinoma of the head and neck: when and how to reirradiate. Head Neck 2015; 37 (1) 134-150
• 31 Vermorken JB, Specenier P. Optimal treatment for recurrent/metastatic head and neck cancer. Ann Oncol 2010; 21 (Suppl. 07) vii252-vii261
• 32 Herle P, Shukla L, Morrison WA, Shayan R. Preoperative radiation and free flap outcomes for head and neck reconstruction: a systematic review and meta-analysis. ANZ J Surg 2015; 85 (3) 121-127
• 33 Vandersteen C, Dassonville O, Chamorey E , et al. Impact of patient comorbidities on head and neck microvascular reconstruction. A report on 423 cases. Eur Arch Otorhinolaryngol 2013; 270 (5) 1741-1746
• 34 Borggreven PA, Kuik DJ, Langendijk JA, Doornaert P, de Bree R, Leemans CR. Severe comorbidity negatively influences prognosis in patients with oral and oropharyngeal cancer after surgical treatment with microvascular reconstruction. Oral Oncol 2005; 41 (4) 358-364
• 35 Stokes WA, Fuller C, Day TA, Gillespie MB. Perioperative survival of elderly head and neck squamous cell carcinoma patients. Laryngoscope 2014; 124 (10) 2281-2286
• 36 Rizvi TA, Rashid M, Ahmed B , et al. Quality of life assessment in patients with locally advanced head and neck malignancy after ablative surgery and reconstruction with microvascular free flaps. J Coll Physicians Surg Pak 2009; 19 (2) 108-112