목적: The cancer incidence of elderly population has been continuously rising and their treatment has been increasingly concern to oncologists. This study aimed to evaluate the incidence and risk factors of morbidity and mortality after major oncological surgery for the elderly head and neck squamous cell carcinoma (HNSCC) patients. 방법:This study included 196 HNSCC patients aged 55 years or more who undergone major curative surgery. Patients were categorized into three groups: far old (≥ 75 years, n=41), old (65~74 years, n=72), and middle-aged (55~64 years, n=83) groups. The rates of early and late postoperative complications, hospital stays, mortality were compared among three groups. Univariate and multivariate analyses were performed to identify clinicopathologic characteristics or perioperative laboratory findings associated with early postoperative complications. 결과:Mean ASA and Charlson comorbidity index (CCI) score, operation time, hospital stay,intensive care unit stay, early postoperative complications, readmission and index cancer or non-cancer mortality were the highest in far-old aged group. The Far-old group had significantly higher mean CCI scores (P < 0.001), regional recurrence rate (P = 0.034) compared with the old group. Multivariate analyses showed that hospital day (P < 0.001), preoperative albumin (P = 0.017), postoperative hemoglobin (P = 0.012) and C-reactive protein (P = 0.002) were independent predictors for early postoperative complications. 결론:In elderly patients, chronological age affects the increased risk of postoperative morbidity and mortality after major oncological surgery for HNSCC. Elderly HNSCC patients, particularly with risk factors, should be carefully monitored for the potential occurrence of postsurgical complication.