Q1. Is there any benefit to adaptive surgery in curative cases?
Q2. Is there any threshold for adaptive surgery?
Q3. Do surgeries in the elderly take longer than in non-elderly head and neck cancers?
Q4. Are there more post-operative complications in the elderly?
Major head and neck cancer surgery for ablation and reconstruction is increasingly being performed in elderly patients (>65 years). There has been concern in the UK that some treatments are altered to provide cure but withholding prolonged surgical procedures due to the risk of post operative complications.
In fact 48% of patients diagnosed with head and neck cancer annually in the UK are over the age of 75 years (classified as ‘very old’). The eligibility of such patients for curative surgery is often tempered by notions such increased failure rate which may or may not be evidence-based. This has given rise to the notion of ‘adaptive surgery’ – whereby surgical protocols are truncated.
Methods: We retrospectively analysed a cohort of elderly head and neck cancer patients operated on at our busy regional centre over the last 5 years. We compared them to a younger population matched for pathology and surgical protocol to assess
the duration of surgery,
length of ITU-HDU care and hospital stay,
the effects of non-adaptive surgery in terms of tumour recurrence.
Finally, we propose a set of guidelines to inform the surgical practice of head and neck cancer in the elderly.
Conflict of interest: None declared.