Microvascular Reconstructions in Elderly Patients With Oral Squamous Cell Carcinoma - Too Old for Surgical Treatment?

Study design: Retrospective cohort study.

Objective: A major risk factor for oral squamous cell carcinoma (OSCC) is advanced age. Ablative surgery combined with microvascular reconstruction has become routine for OSCC. Nevertheless, there is an interdisciplinary debate about the appropriateness of surgery combined with prolonged general anesthesia in the elderly. In the present study, the ablative and microvascular strategies in OSCC were evaluated in terms of oncologic safety and surgical morbidity in relation to age.

Methods: A total of 345 patients with primary OSCC who underwent ablative tumor surgery and neck dissection according to the German national guideline for OSCC together with microvascular reconstruction from September 2010 to October 2017 were examined. General clinical data was analyzed descriptively with a special focus on perioperative morbidity of an elderly (≥70y) subgroup of 56 patients. Oncological outcome was estimated using Log Rank testing and Kaplan Meier plotting.

Results: Estimated 5 year overall survival (OS) and disease-free survival (DFS) was 69.6% (≥70y) vs. 76.7% (<70y) and 62.9% (≥70y) vs. 78.2% (<70y) respectively with no significant difference between the 2 age groups. In multivariate cox regression, only initial stage of disease revealed significant impact on OS. Analysis of perioperative death/complications, flap loss, operation time, dependence on tracheostomy and hospitalization revealed no significant differences between the 2 groups.

Conclusions: Tumor surgery including neck dissection in combination with primary microvascular reconstruction is a safe therapy in patients of advanced age. This results in excellent oncological outcome with no significant disadvantages in terms of perioperative morbidity, hospitalization or flap failure.