title: Unravelling the risk factors that underlie laryngeal surgery in elderly.
abstract: Older patients are not considered good candidates to undergo more challenging therapeutic treatments, e.g. highly invasive surgery and complex chemotherapy. However, their exclusion from standard therapeutic options is not justifiable. Herein, we reviewed 212 patients aged ≥ 70, affected with laryngeal squamous cell carcinoma, and treated with transoral laser microsurgery or open neck (partial / total) laryngectomy with radical intent. The main aim was to compare patient outcomes to identify predictive factors that can be used by surgeons to choose the most appropriate treatment option. In our cohort, patients affected with more advanced tumour and hence treated by invasive open neck surgeries (above all TL) are more prone to develop complications and undergo fatal outcome than those with early disease treated by laser microsurgery, independently of age at surgery. In conclusion, elderly patients affected by laryngeal cancer can be treated similarly to younger patients, keeping in mind that more invasive surgeries are associated with a higher risk of developing complications. The advantages of mini-invasive surgery make it a possible first choice treatment in very old and frail patients suffering from laryngeal cancer, especially considering the recent success in treatment of some advanced stage tumours. Furthermore, comorbidities, by themselves, should not be used as exclusion criteria for subjecting an elderly patient to a different treatment that is from standard therapy.
authors.affiliation: Head and Neck Service, Candiolo Cancer Institute, FPO IRCCS, Candiolo (TO), Italy;
authors.forename: E
authors.initials: E
authors.lastname: Crosetti
authors.affiliation: Otorhinolaryngology Service, San Luigi Gonzaga Hospital, University of Turin, Italy;
authors.forename: A
authors.initials: A
authors.lastname: Caracciolo
authors.affiliation: Otorhinolaryngology Service, Policlinico di Modena Hospital, University of Modena, Department of Head and Neck Surgery, Modena, Italy;
authors.forename: G
authors.initials: G
authors.lastname: Molteni
authors.affiliation: Department of Clinical and Biological Sciences, University of Turin, Italy.
authors.forename: A E
authors.initials: AE
authors.lastname: Sprio
authors.affiliation: Department of Clinical and Biological Sciences, University of Turin, Italy.
authors.forename: G N
authors.initials: GN
authors.lastname: Berta
authors.affiliation: Otorhinolaryngology Service, Policlinico di Modena Hospital, University of Modena, Department of Head and Neck Surgery, Modena, Italy;
authors.forename: L
authors.initials: L
authors.lastname: Presutti
authors.affiliation: Otorhinolaryngology Service, San Luigi Gonzaga Hospital, University of Turin, Italy;
authors.forename: G
authors.initials: G
authors.lastname: Succo
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D005260:Female; D006801:Humans; D007822:Laryngeal Neoplasms / Q000601:surgery*; D007825:Laryngectomy / Q000009:adverse effects* / Q000379:methods; D053685:Laser Therapy / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008866:Microsurgery; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors
keywords: Elderly; Laryngeal cancer; Open partial laryngectomy; Supracricoid partial laryngectomy; Total laryngectomy; Transoral laser microsurgery