Introduction: Surgical management of complex head and neck (H&N) cancer in elderly remains a clinical dilemma from advanced pathology, perceived reduced fitness and finite healthcare resources.
From 2020, a streamlined H&N service consisting of a multidisciplinary (MDM) specialties team was developed in Waikato Hospital to manage all complex head and neck under Plastic Surgery. We would like to investigate our experience of managing elderly patients with published results in medical literature.
Methods
Patients who had been managed for head and neck cancer in Waikato Plastic Surgery from July 2020 onwards were identified from our prospective H&N electronic database with cross-reference from theatre records.
A standardised proforma was used for data collection and analysis.
Results
We have operated on 160 patients under Plastic Surgery as part of MDM for major H&N cancer over 24 months.
Patients above 69 years at the time of surgery comprised of 26 patients with free flap reconstruction (Group 1), 2 regional flaps (Group 2) and
21 with locally invasive tumours treated via excision, bone chiseling and skin substitute reconstruction plus immediate adjuvant radiotherapy (Group 3).
Group 1 has 100% flap success, no partial necrosis, 21% 30 days serious complications, none with 90 days mortality (chi-squared p=0.05 when compared with USA study and p=0.02 with Italy study). Mean follow up was 9.8 months with no recurrence detected. 96% patients returned to pre-operative functional state post surgery.
Group 3 has no recurrence over a mean follow up of 8.5 months and only 1 was treated with skin graft after adjuvant radiotherapy. One patient died from COVID19-related complication 2 months after surgery; All 19 patients with up to half scalp wound defect had complete skin substitute integration (G2F p=0.0006).
Conclusion
Complex H&N cancer surgery and reconstruction can be safely delivered to elderly patients with good clinical outcomes in Waikato.