A nationwide analysis of salvage surgery for laryngeal cancer in the elderly.
National Cancer Database
elderly
head and neck cancer
laryngectomy
Journal
Head & neck
ISSN: 1097-0347
Titre abrégé: Head Neck
Pays: United States
ID NLM: 8902541
Informations de publication
Date de publication:
11 2023
11 2023
Historique:
revised:
13
08
2023
received:
12
06
2023
accepted:
05
09
2023
medline:
23
10
2023
pubmed:
22
9
2023
entrez:
22
9
2023
Statut:
ppublish
Résumé
We aim to describe outcomes of elderly patients undergoing salvage surgery for laryngeal cancer and to characterize the interplay of age with various other factors in this growing population. Using the National Cancer Database, we identified cases of salvage laryngectomy in patients who failed chemoradiation. An age cutoff of 70 years was used to separate subjects into two groups. Various factors were compared. Of the 825 patients included, 166 (20.1%) were elderly. Elderly patients had worse overall survival (p = 0.001), higher 30-day and 90-day mortality (p = 0.006, p < 0.001), and a longer length of stay (LOS) (p = 0.015). LOS over 1 week was associated with worse survival (p = 0.032). Elderly patients had worse overall perioperative survival than their younger counterparts. LOS and 30-day readmissions were associated with higher risk of mortality in this group. We provide a contemporary set of relevant information for head and neck cancer providers to consider in this growing population.
Sections du résumé
BACKGROUND
We aim to describe outcomes of elderly patients undergoing salvage surgery for laryngeal cancer and to characterize the interplay of age with various other factors in this growing population.
METHODS
Using the National Cancer Database, we identified cases of salvage laryngectomy in patients who failed chemoradiation. An age cutoff of 70 years was used to separate subjects into two groups. Various factors were compared.
RESULTS
Of the 825 patients included, 166 (20.1%) were elderly. Elderly patients had worse overall survival (p = 0.001), higher 30-day and 90-day mortality (p = 0.006, p < 0.001), and a longer length of stay (LOS) (p = 0.015). LOS over 1 week was associated with worse survival (p = 0.032).
CONCLUSION
Elderly patients had worse overall perioperative survival than their younger counterparts. LOS and 30-day readmissions were associated with higher risk of mortality in this group. We provide a contemporary set of relevant information for head and neck cancer providers to consider in this growing population.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2915-2924Informations de copyright
© 2023 Wiley Periodicals LLC.
Références
Siegel R, Miller K, Jemal A. Cancer statistics, 2018. CA Cancer J Clin. 2018;68:7-30. doi:10.3322/caac.21442
The American Cancer Society. Key Statistics for Laryngeal and Hypopharyngeal Cancers.
Bonomi MR, Blakaj A, Blakaj D. Organ preservation for advanced larynx cancer: a review of chemotherapy and radiation combination strategies. Oral Oncol. 2018;86:301-306. doi:10.1016/j.oraloncology.2018.10.004
Eskander A, Blakaj DM, Dziegielewski PT. Decision making in advanced larynx cancer: an evidenced based review. Oral Oncol. 2018;86:195-199. doi:10.1016/j.oraloncology.2018.09.019
Forastiere AA, Zhang Q, Weber RS, et al. Long-term results of RTOG 91-11: a comparison of three nonsurgical treatment strategies to preserve the larynx in patients with locally advanced larynx cancer. J Clin Oncol. 2013;31(7):845-852. doi:10.1200/JCO.2012.43.6097
Silverman DA, Puram SV, Rocco JW, Old MO, Kang SY. Salvage laryngectomy following organ-preservation therapy-an evidence-based review. Oral Oncol. 2019;88:137-144. doi:10.1016/j.oraloncology.2018.11.022
Department of Veterans Affairs Laryngeal Cancer Study Group, Wolf GT, Fisher SG, et al. Induction chemotherapy plus radiation compared with surgery plus radiation in patients with advanced laryngeal cancer. N Engl J Med. 1991;324(24):1685-1690. doi:10.1056/NEJM199106133242402
Forastiere AA, Goepfert H, Maor M, et al. Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer. N Engl J Med. 2003;349(22):2091-2098. doi:10.1056/NEJMoa031317
Network NCC. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines): Head and Neck Cancers.
National Cancer Database: Hospital Comparison Benchmark Reports Cases Diagnosed 2000-2008. American College of Surgeons Commission on Cancer.
van der Putten L, de Bree R, Kuik DJ, et al. Salvage laryngectomy: oncological and functional outcome. Oral Oncol. 2011;47(4):296-301. doi:10.1016/j.oraloncology.2011.02.002
León X, Quer M, Orús C, López M, Gras JR, Vega M. Results of salvage surgery for local or regional recurrence after larynx preservation with induction chemotherapy and radiotherapy. Head Neck. 2001;23(9):733-738. doi:10.1002/hed.1104
Li M, Lorenz RR, Khan MJ, et al. Salvage laryngectomy in patients with recurrent laryngeal cancer in the setting of nonoperative treatment failure. Otolaryngol Head Neck Surg. 2013;149(2):245-251. doi:10.1177/0194599813486257
Weber RS, Berkey BA, Forastiere A, et al. Outcome of salvage total laryngectomy following organ preservation therapy: the Radiation Therapy Oncology Group trial 91-11. Arch Otolaryngol Head Neck Surg. 2003;129(1):44-49. doi:10.1001/archotol.129.1.44
Aarts MCJ, Rovers MM, Grau C, Grolman W, van der Heijden GJM. Salvage laryngectomy after primary radiotherapy: what are prognostic factors for the development of pharyngocutaneous fistulae? Otolaryngol Head Neck Surg. 2011;144(1):5-9. doi:10.1177/0194599810390914
Schwartz SR, Yueh B, Maynard C, Daley J, Henderson W, Khuri SF. Predictors of wound complications after laryngectomy: a study of over 2000 patients. Otolaryngol Head Neck Surg. 2004;131(1):61-68. doi:10.1016/j.otohns.2003.08.028
Timmermans AJ, Lansaat L, Theunissen EAR, Hamming-Vrieze O, Hilgers FJM, van den Brekel MWM. Predictive factors for pharyngocutaneous fistulization after total laryngectomy. Ann Otol Rhinol Laryngol. 2014;123(3):153-161. doi:10.1177/0003489414522972
Cire B. World's Older Population Grows Dramatically. National Institute of Aging, NIH.
Wan H, Goodkind D, Kowal P. An Aging World: 2015 International Population Reports. National Institute of Aging, NIH; 2015.
Vincent G, Velkoff V. The Next Four Decades, the Older Population in the United States: 2010 to 2050 (Current Population Reports). US Census Bureau; 2010.
United Nations Population Division/United Nations Population Division. World Population Ageing: 1950-2050.
Rao A, Cohen H. Oncology and aging: general principles. Hazzard's Geriatric Medicine and Gerontology. 6th ed. McGraw-Hill; 2009.
Arriaga MA, Kanel KT, Johnson JT, Myers EN. Medical complications in total laryngectomy: incidence and risk factors. Ann Otol Rhinol Laryngol. 1990;99(8):611-615. doi:10.1177/000348949009900804
Lusardi JJ, Buchanan PM, Christopher KM, Varvares MA. Salvage surgery following radiation failure for laryngeal cancer in elderly patients. Otolaryngol Head Neck Surg. 2011;145(5):759-766. doi:10.1177/0194599811414396
National Cancer Database. https://www.facs.org/cancer/NCDB/index.html
Deyo RA, Cherkin DC, Ciol MA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol. 1992;45(6):613-619. doi:10.1016/0895-4356(92)90133-8
Balducci L. Management of cancer in the elderly. Oncology. 2006;20(2):135-143; discussion 144, 146, 151-152. Accessed September 2022. http://www.ncbi.nlm.nih.gov/pubmed/16562648
Szturz P, Vermorken JB. Treatment of elderly patients with squamous cell carcinoma of the head and neck. Front Oncol. 2016;6:199. doi:10.3389/fonc.2016.00199
Derks W, De Leeuw JRJ, Hordijk GJ, Winnubst JAM. Elderly patients with head and neck cancer: short-term effects of surgical treatment on quality of life. Clin Otolaryngol Allied Sci. 2003;28(5):399-405. doi:10.1046/j.1365-2273.2003.00718.x
Derks W, de Leeuw JRJ, Hordijk GJ, Winnubst JAM. Reasons for non-standard treatment in elderly patients with advanced head and neck cancer. Eur Arch Otorhinolaryngol. 2005;262(1):21-26. doi:10.1007/s00405-004-0744-x
Beausang ES, Ang EE, Lipa JE, et al. Microvascular free tissue transfer in elderly patients: the Toronto experience. Head Neck. 2003;25(7):549-553. doi:10.1002/hed.10240
Bhattacharyya N. A matched survival analysis for squamous cell carcinoma of the head and neck in the elderly. Laryngoscope. 2003;113(2):368-372. doi:10.1097/00005537-200302000-00030
Tzelnick S, Mizrachi A, Shavit SS, et al. Major head and neck surgeries in the elderly population, a match-control study. Eur J Surg Oncol. 2021;47(8):1947-1952. doi:10.1016/j.ejso.2021.06.009
Lin H-S, Watts JN, Peel NM, Hubbard RE. Frailty and post-operative outcomes in older surgical patients: a systematic review. BMC Geriatr. 2016;16(1):157. doi:10.1186/s12877-016-0329-8
Sarini J, Fournier C, Lefebvre JL, Bonafos G, Van JT, Coche-Dequéant B. Head and neck squamous cell carcinoma in elderly patients: a long-term retrospective review of 273 cases. Arch Otolaryngol Head Neck Surg. 2001;127(9):1089-1092. doi:10.1001/archotol.127.9.1089
de Rijke JM, Schouten LJ, Schouten HC, Jager JJ, Koppejan AG, van den Brandt PA. Age-specific differences in the diagnostics and treatment of cancer patients aged 50 years and older in the province of Limburg, the Netherlands. Ann Oncol Off J Eur Soc Med Oncol. 1996;7(7):677-685. doi:10.1093/oxfordjournals.annonc.a010716
Piccirillo JF, Tierney RM, Costas I, Grove L, Spitznagel EL. Prognostic importance of comorbidity in a hospital-based cancer registry. Jama. 2004;291(20):2441-2447. doi:10.1001/jama.291.20.2441
Piccirillo JF, Lacy PD, Basu A, Spitznagel EL. Development of a new head and neck cancer-specific comorbidity index. Arch Otolaryngol Head Neck Surg. 2002;128(10):1172-1179. doi:10.1001/archotol.128.10.1172
Alho O-P, Hannula K, Luokkala A, Teppo H, Koivunen P, Kantola S. Differential prognostic impact of comorbidity in head and neck cancer. Head Neck. 2007;29(10):913-918. doi:10.1002/hed.20608
Reid BC, Alberg AJ, Klassen AC, et al. Comorbidity and survival of elderly head and neck carcinoma patients. Cancer. 2001;92(8):2109-2116. doi:10.1002/1097-0142(20011015)92:8<2109::aid-cncr1552>3.0.co;2-m
Datema FR, Ferrier MB, van der Schroeff MP, Baatenburg de Jong RJ. Impact of comorbidity on short-term mortality and overall survival of head and neck cancer patients. Head Neck. 2010;32(6):728-736. doi:10.1002/hed.21245
Derks W, de Leeuw RJ, Hordijk GJ. Elderly patients with head and neck cancer: the influence of comorbidity on choice of therapy, complication rate, and survival. Curr Opin Otolaryngol Head Neck Surg. 2005;13(2):92-96. doi:10.1097/01.moo.0000156169.63204.39
Sanabria A, Carvalho AL, Melo RL, et al. Predictive factors for complications in elderly patients who underwent head and neck oncologic surgery. Head Neck. 2008;30(2):170-177. doi:10.1002/hed.20671
Genther DJ, Gourin CG. Effect of comorbidity on short-term outcomes and cost of care after head and neck cancer surgery in the elderly. Head Neck. 2015;37(5):685-693. doi:10.1002/hed.23651
Goldstein DP, Sklar MC, de Almeida JR, et al. Frailty as a predictor of outcomes in patients undergoing head and neck cancer surgery. Laryngoscope. 2020;130(5):E340-E345. doi:10.1002/lary.28222
Anpalahan M, Gibson SJ. Geriatric syndromes as predictors of adverse outcomes of hospitalization. Intern Med J. 2008;38(1):16-23. doi:10.1111/j.1445-5994.2007.01398.x
Lapointe J. Strategies to Reduce Hospital Readmission Rates, Costs. RevCycle Intelligence Xtelligent Healthcare Media. 2018. Accessed September 2022. https://revcycleintelligence.com/news/3-strategies-to-reduce-hospital-readmission-rates-costs
van Walraven C, Dhalla IA, Bell C, et al. Derivation and validation of an index to predict early death or unplanned readmission after discharge from hospital to the community. CMAJ. 2010;182(6):551-557. doi:10.1503/cmaj.091117
Puram SV, Bhattacharyya N. Identifying metrics before and after readmission following head and neck surgery and factors affecting readmission rate. Otolaryngol Head Neck Surg. 2018;158(5):860-866. doi:10.1177/0194599817750373
Goel AN, Raghavan G, St John MA, Long JL. Risk factors, causes, and costs of hospital readmission after head and neck cancer surgery reconstruction. JAMA Facial Plast Surg. 2019;21(2):137-145. doi:10.1001/jamafacial.2018.1197
Chen MM, Orosco RK, Harris JP, et al. Predictors of readmissions after head and neck cancer surgery: a national perspective. Oral Oncol. 2017;71:106-112. doi:10.1016/j.oraloncology.2017.06.010
Dziegielewski PT, Boyce B, Manning A, et al. Predictors and costs of readmissions at an academic head and neck surgery service. Head Neck. 2016;38(Suppl 1):E502-E510. doi:10.1002/hed.24030
Stitzenberg KB, Chang Y, Smith AB, Nielsen ME. Exploring the burden of inpatient readmissions after major cancer surgery. J Clin Oncol. 2015;33(5):455-464. doi:10.1200/JCO.2014.55.5938
Birkmeyer JD, Dimick JB, Birkmeyer NJO. Measuring the quality of surgical care: structure, process, or outcomes? J Am Coll Surg. 2004;198(4):626-632. doi:10.1016/j.jamcollsurg.2003.11.017
Graboyes EM, Liou T-N, Kallogjeri D, Nussenbaum B, Diaz JA. Risk factors for unplanned hospital readmission in otolaryngology patients. Otolaryngol Head Neck Surg. 2013;149(4):562-571. doi:10.1177/0194599813500023
Jencks SF, Williams MV, Coleman EA. Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med. 2009;360(14):1418-1428. doi:10.1056/NEJMsa0803563
David JM, Ho AS, Luu M, et al. Treatment at high-volume facilities and academic centers is independently associated with improved survival in patients with locally advanced head and neck cancer. Cancer. 2017;123(20):3933-3942. doi:10.1002/cncr.30843
Gourin CG, Stewart CM, Frick KD, et al. Association of hospital volume with laryngectomy outcomes in patients with larynx cancer. JAMA Otolaryngol Head Neck Surg. 2019;145(1):62-70. doi:10.1001/jamaoto.2018.2986
Nocon CC, Ajmani GS, Bhayani MK. Association of facility volume with positive margin rate in the surgical treatment of head and neck cancer. JAMA Otolaryngol Head Neck Surg. 2018;144(12):1090-1097. doi:10.1001/jamaoto.2018.2421
Helman SN, Brant JA, Moubayed SP, Newman JG, Cannady SB, Chai RL. Predictors of length of stay, reoperation, and readmission following total laryngectomy. Laryngoscope. 2017;127(6):1339-1344. doi:10.1002/lary.26454