Survival and prognosis of surgical head and neck cancer patients aged 80 years and older

INTRODUCTION: Elderly patients (≥80 years of age) with head and neck cancer (HNC) can prove a management challenge due to concerns regarding their suitability for surgery. This study aims to describe the characteristics and outcomes of elderly patients undergoing HNC surgery. METHODS: A retrospective review of elderly patients undergoing HNC surgery was conducted. Demographics, comorbidities, tumor characteristics, surgical procedure type, postoperative complications, and disposition were reviewed. Overall survival (OS) in the elderly cohort was compared against younger patients (<80 years). RESULTS: A total of 595 patients were included, of whom 86 were aged >80 years (71% male; mean age 84.8, range 80.0–98.8 years). The overall complication rate was 43%. When compared with younger patients (n = 509), elderly patients had reduced OS (risk ratio: 2.0, 95% CI: 1.3–3.2), higher 90‐day mortality (8.1% vs. 2.3%, p = .005), and lower 5‐year survival (43.5% vs. 64.1%, p < .001). However, survival was comparable to age‐specific life expectancy. There was no difference in OS, 90‐day mortality, and 5‐year survival when comparing >85 (n = 33) and 80–85 (n = 53) age groups. CONCLUSIONS: Chronological age alone should not negatively influence decision‐making in HNC surgery the elderly. With careful preoperative selection and optimization, surgery can be performed at acceptable risk with good outcomes in elderly patients. LEVEL OF EVIDENCE: IV