Komplikationen nach chirurgischer Therapie von Malignomen der Kopf- und Hals-Region bei Patienten in fortgeschrittenem Lebensalter - Eine Evaluation anhand des McPeek-Outcome-Scores

Ziel der vorliegenden retrospektiven Untersuchung ist es, etwaige Unterschiede hinsichtlich des postoperativen Outcomes älterer und jüngerer Patienten offenzulegen, um gegebenenfalls eine Entscheidungshilfe hinsichtlich der chirur-gischen Behandlung älterer Patienten an die Hand zu bekommen. Zu dies...

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Bibliographic Details
Main Author: Schotte, Tobias Lennart
Contributors: Sesterhenn, Andreas M. (Prof. Dr.) (Thesis advisor)
Format: Doctoral Thesis
Published: Philipps-Universität Marburg 2011
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There is international consensus that elderly patients with head and neck cancer should be treated curatively like younger patients. Expanded life expectancy leads us to expect that many elderly patients with head and neck cancers will require surgical treatment. Because of common comorbidities in elderly patients, perioperative complications are likely. In this retrospective study, we used the McPeek postoperative outcome score to evaluate the success of surgical interventions including neck dissection in patients with head and neck cancers. A total of 168 patients were included in the study (study group: n=56, ≥75y; control group: n=112, ≤60y). All patients underwent major surgery as a part of comprehensive oncologic treatment. Median McPeek score was 8 in the study group vs. 9 in the control group (p=0.04). An ASA physical status score of 3 was more frequent in the study group than in the control group (p=0.00002). Mean duration of surgery was 334±136 minutes in the study group and 303±171 minutes in the control group (95% CI: 0.994-0.999, p=0.0015). There were no major intraoperative complications. Regression analysis revealed that neither age (95% CI: 0.285-1.243, p=0.085) nor ASA score (95% CI: 0.611-2.112, p=0.342) were independent predictors for McPeek scoring. However, synchronous surgical intervention (95% CI: 0.087-0.521, p=0.00051) and duration of surgery (95% CI: 0.994-0.999, p=0.0015) had signifi-cant impact on McPeek score. The results of the present study confirm that outcome after surgery for elderly patients with head and neck cancers differs from that of their younger counter-parts. Since postoperative outcome depends on duration of surgery and the extent of the intervention, therapy must take into account specific comorbidities in elderly patients.