Abstract
We report the cases of two super-elderly patients with mandibular gingival carcinoma who underwent surgery and were retrospectively evaluated using a patient evaluation tool. Patient 1 was a 93-year-old man with mandibular gingival carcinoma （cT4aN0M0） who underwent tracheostomy, neck dissection, and segmental mandibulectomy. Postoperatively, he developed pleural effusion and pneumonia but was discharged 31 days after surgery. Five years post-surgery, he maintains the same activities of daily living （ADL） as before surgery, with no recurrence of the carcinoma.
Patient 2 was a 93-year-old man with mandibular gingival carcinoma （cT4aN1M0） who underwent tracheostomy, neck dissection, segmental mandibulectomy, and reconstruction using a pectoralis major musculocutaneous flap. He experienced postoperative pleural effusion and pneumonia, which improved; however, he suffered a severe hemorrhage six weeks postoperatively and severe arrhythmia nine weeks postoperatively. He was transferred to another hospital twelve weeks after surgery and died of recurrent pneumonia four weeks later.
The patient evaluation tools included life expectancy, American Society of Anesthesiologists classification, Performance Status, Charlson Comorbidity Index, Prognostic Nutritional Index, Mini Nutritional Assessment, Geriatric-8, Vulnerable Elders Survey-13, Flemish Version of the Triage Risk Screening Tool, Japan Clinical Oncology Group classification for the elderly, Clinical Frailty Scale, Frailty-Index, basic checklist, Functional Oral Intake Scale, Food Intake Level Scale, and Estimation of Physiologic Ability and Surgical Stress. These results suggest that even in very elderly patients with oral cancer, surgery may be considered based on their general condition and that it may be important to reduce the invasiveness of surgery. As useful tools for patient evaluation and prognostic factors are not yet available, it is necessary to study more cases in the future.
