Age and Surgical Treatment of Laryngeal Carcinoma

Overview

The prolongation of human age implies also an increase of elderly patients with carcinoma of the larynx. In a retrospective study of the ENT Clinic of the Third Medical Faculty Charles University and Faculty Hospital 10 made in 1990-1999 including 143 patients with carcinoma of the larynx there were 24% patients older than 70 yeas.From the investigation ensues that patients with carcinoma of the larynx above 70 years of age are usually afflicted by a lower stage of the disease (79 % of the patients above 70 years in stages I and II as compared with 56% patients in stages III and IV in patients under 70 years). Also metastases into cervical nodes are less frequent in older patients (in 6 as compared with 32 in patients under 70 years). In both group the tumour is most frequently in the area of the glottis. In older patients this site is even more frequent (60% tumours in patients under 70 years of age as compared with 91% glottis and transglottic tumours in patients above 70 years). The general preoperative conditions in older patients is worse (82% patients with a risk of anaesthaemia ASA III and IV and only 18% patients with ASA I and II as compared with 40% patients with ASA I and II and 60% with ASA III and IV in patients under 70 years of age.With regard to the advances of anaesthesiology and advances in preoperative preparation and subsequent postoperative care there is however no substantial difference between the two groups as regards treatment. In both groups the main part is played by surgical treatment (possibly with postoperative actinotherapy) (62 % primarily surgically treated older patients as compared with 71% patients under 70 years treated similarly). The main reason of conservative non-surgical treatment in younger patients is, if we eliminate cases where primary actinotherapy was offered to patients as optimal therapy, an inoperable size of the tumour. In patients above 70 the main cause of a conservative procedure was refusal of surgery and the general health status. Postoperative complications were recorded in 12.1% patients under 75 years and in 14% above 75 years. As postoperative complications are influenced more than by age by the size of the tumour, the extent of surgery and the general health status of the patient. The achieved 5-year survival in patients under 70 years - 61% - and 82% in patients above 70 years provides evidence that age does not affect in a major way the probability of 5-year survival. Decisive is in the first place the size of the tumour and presence of secondaries.From the results ensues that age alone is no reason for a change of standard oncological procesures, it is not a contraindication of surgical procedures (incl. partial laryngectomy).

Key words:
carcinoma of the larynx - surgical treatment - elderly patients