Patel Viraj M, Stern Carrie, Miglani Amar, Weichman Katie E, Lin Juan, Ow Thomas J, Garfein Evan S
Division of Plastic and Reconstructive Surgery, The Department of Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York.
Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York.
J Reconstr Microsurg. 2017 Jun;33(5):336-342. doi: 10.1055/s-0037-1598621. Epub 2017 Feb 24.
In patients with head and neck squamous cell carcinoma (HNSCC), disease recurrence remains a significant obstacle to long-term survival. If possible, surgical salvage with reconstruction remains the best treatment option for patients with recurrence. Currently, there is no literature discussing whether age should preclude microvascular reconstruction in these patients. We hypothesize that older age alone does not affect outcomes. A retrospective chart review of patients with HNSCC at our institution between 2008 and 2015 was performed. Patients were included if they underwent simultaneous resection and flap reconstruction for recurrent HNSCC. Data collected included age, sex, primary site, type of reconstruction, previous treatments, postoperative complications (systemic and reconstructive), and overall survival. A total of 65 patients met inclusion criteria for the review: 42 (64.6%) patients ≤70 years and 23 (35.4%) patients > 70 years. Overall survival was not significantly different between the younger and older groups ( = 0.199). Five-year survival was 60.1% in the younger group and 46.8% in the older group. No significant difference was found in reconstructive complication rates ( = 0.179) or systemic complication rates ( = 0.241) between the two groups. Multivariate logistic regression analysis further showed no significant association between patients' age (≤70 years or > 70 years) and reconstructive complications ( = 0.396) or systemic complications ( = 0.119). Age is not significantly associated with complications among patients undergoing resection and reconstruction for recurrent HNSCC. Microvascular reconstruction remains a feasible option in older patients with recurrent HNSCC. Advanced age alone should not preclude the surgical management of recurrent HNSCC.
在头颈部鳞状细胞癌(HNSCC)患者中,疾病复发仍然是长期生存的重大障碍。如果可能的话,手术挽救并重建仍然是复发患者的最佳治疗选择。目前,尚无文献讨论年龄是否应排除这些患者进行微血管重建的可能性。我们假设仅年龄因素不会影响治疗结果。
对2008年至2015年间在我们机构就诊的HNSCC患者进行了回顾性病历审查。纳入标准为因复发性HNSCC同时接受切除和皮瓣重建的患者。收集的数据包括年龄、性别、原发部位、重建类型、既往治疗、术后并发症(全身和重建相关)以及总生存期。
共有65例患者符合审查的纳入标准:42例(64.6%)患者年龄≤70岁,23例(35.4%)患者年龄>70岁。年轻组和老年组的总生存期无显著差异(P = 0.199)。年轻组的5年生存率为60.1%,老年组为46.8%。两组之间的重建并发症发生率(P = 0.179)或全身并发症发生率(P = 0.241)均无显著差异。多因素逻辑回归分析进一步显示,患者年龄(≤70岁或>70岁)与重建并发症(P = 0.396)或全身并发症(P = 0.119)之间无显著关联。
对于复发性HNSCC患者,在接受切除和重建治疗时,年龄与并发症无显著关联。微血管重建对于老年复发性HNSCC患者仍然是一种可行的选择。仅高龄不应排除复发性HNSCC的手术治疗。