The Assessment and Outcomes of Head and Neck Cancer Surgical Treatment and Reconstruction in Patients of 80 Years or Older - Case Series Study

80歲以上之頭頸癌症病患治療及重建手術評估及預後－病例系列研究

賴東懋(Tung-Mao Lai) ； 馮冠明(Guan-Ming Feng)

《臺灣整形外科醫學會雜誌》 29卷3期 (2020/09) Pp. 165-177

摘要

Background: As average life expectancy has extended to about 80 years, patients who are diagnosed with head and neck cancer at ages above 80 are increasingly more likely to receive curative surgery instead of palliative treatment. A high success rate of reconstruction surgery for patients over 60 years has been proven by many researchers. However, the outcomes of tumor eradication with reconstruction surgery for patients age 80 or older has not been fully investigated. Aim and Objectives: We compared the patient's characteristics, flap success rate, complication rate, patient survival rate, and tumor recurrence rate between a group of advanced age (＞ 80 years old) and a younger population (65-79 years old). Materials and Methods: We screened all patients with a diagnosis of head and neck cancer from 2006 to 2019 in E-da tertiary-care hospital. We retrospectively reviewed the pre-operative assessment, operation method, and post-operative outcomes and complications of the patients. Their details were recorded. Results: There were 18 cases diagnosed at age 80+; most of them had stage IV head and neck cancer. Their overall flap survival rate was 100%, their complication rate was 22.3%, and their surgical mortality rate was 11.1%. Eight patients (44.4%) had a disease-free life span of more than 4 years. The tumor recurrence rate was 22.2%. Although they had a slightly lower 5-year survival rate than the younger group, there was no significant difference in the flap successful rate, complication rate, or patient survival rate between the two age groups. Conclusion: Surgical treatment for head and neck cancer in patients with age ＞ 80 is feasible and can have a favorable outcome. It also provides for a better life quality for the patients, even in advanced age groups.

關鍵字

old age ； reconstruction ； head and neck ； flap success rate ； complications

並列摘要

背景：頭頸癌目前的主要治療方式為腫瘤切除及重建手術、化學治療、以及放射線治療。過去多項研究證實對於60歲以上病患群，重建手術依然有相當高之成功率。然而由於醫療進展，人類平均壽命已接近80歲。對於更高齡之頭頸癌治療成效仍有待研究。目的及目標：以回溯性分析頭頸癌病患資料庫，比較年齡大於80歲之病患與年輕病患群（年齡65-79歲）在手術預後及併發症之探討。材料及方法：我們分析在義大醫院2006至2019年間頭頸癌病患資料，收錄年齡大於80歲並接受腫瘤切除及重建手術之病患。回溯記錄其術前評估、手術方式、及術後成果與併發症之資料。結果：總共有18位病患收錄進此研究。其中大部分為第四期腫瘤，而美國麻醉協會分級指標皆介於2至3級。皮瓣存活率為100%，併發症發生率為22.3%，而手術併發死亡率為11.1%。8位病患存活超過4年。腫瘤復發率為22.2%。同時亦有紀錄病患術後之飲食方式及口語能力。結論：對於年齡80歲之頭頸癌病患，手術治療是可行的，並且能帶來良好之預後。即使是高齡病患，手術也能帶來病患更佳的生活品質。