Unravelling the risk factors that underlie laryngeal surgery in elderly

Old patients are not considered good candidates to undergo more challenging therapeutic treatments, e.g. highly invasive surgery and complex chemotherapy. But, their exclusion from standard therapeutic options should be not justifiable. Here, we reviewed 212 patients aged ≥70, afflicted with laryngeal squamous cell carcinoma, and treated with radical purpose by transoral laser microsurgery or open neck (partial / total) laryngectomy. The main aim was to compare the patient outcomes in order to identify predictive factors employable by surgeons to choose the most opportune treatment option. In our cohort, patients affected with more advanced tumor and hence treated by invasive open neck surgeries (above all TL) are more prone to develop complications and undergo fatal outcome with respect to those with early disease treated by laser microsurgery, independently from the age at surgery. In conclusion, elderly patients affected by laryngeal cancer can be treated as well as younger patients, keeping in mind that more invasive surgeries lead to higher risk to develop complications. The advantages of mini-invasive surgery place it as possible first choice treatment in very old and frail patients suffering from laryngeal cancer, above all after the recent success in the treatment of some advanced stage tumors. Furthermore, comorbidities, in themselves, don’t supply justifications to subjecting elderly to a different treatment from standard.