Subscribe to RSS
DOI: 10.1055/s-0033-1357277
Microsurgical Reconstruction for Head and Neck Cancer in Elderly Patients
Publication History
14 March 2013
02 August 2013
Publication Date:
09 December 2013 (online)
![](https://www.thieme-connect.de/media/jrm/201402/lookinside/thumbnails/10.1055-s-0033-1357277-1.jpg)
Abstract
The purpose of this study is to review our group of elderly patients and examine whether microsurgical reconstruction is safe to perform in these cases. From October 2006 to October 2009, 747 patients with head and neck cancer who underwent free flap reconstruction were divided into two groups: patients younger than 70 years (n = 714) and patients older than 70 years (n = 33). The two groups of patients were compared regarding medical comorbidities, medical/surgical complications, smoke, and alcohol consumption and outcomes. Two deaths occurred in the “elderly” (6% mortality rate) group of patients and two deaths in the “young” group of patients (0.28% mortality rate) in the immediate postoperative period (15 days postoperatively). Thus, mortality rate had a significant difference (p = 0.011) between these two groups. There was no significant difference in morbidity between these two groups of patients regarding the rate of medical complications, surgical complications, flap failure, and reexploration during our 3-month follow-up period. Mortality risk is higher in the elderly group of patients. However, there is no significant difference regarding the free flap success rate between these two groups. Thorough preoperative evaluation and preparation are critical to achieve a favorable outcome in elderly patients.
-
References
- 1 Bell FC, Miller ML. Life Tables for the United States Social Security Area, 1900–2100. Actuarial Study No. 116. Baltimore, MD: Social Security Administration; 2002
- 2 Ziffren SE, Hartford CE. Comparative mortality for various surgical operations in older versus younger age groups. J Am Geriatr Soc 1972; 20 (10) 485-489
- 3 Wolters U, Wolf T, Stützer H, Schröder T. ASA classification and perioperative variables as predictors of postoperative outcome. Br J Anaesth 1996; 77 (2) 217-222
- 4 Singh B, Cordeiro PG, Santamaria E, Shaha AR, Pfister DG, Shah JP. Factors associated with complications in microvascular reconstruction of head and neck defects. Plast Reconstr Surg 1999; 103 (2) 403-411
- 5 Chen HC, Coskunfirat OK, Ozkan O , et al. Guidelines for the optimization of microsurgery in atherosclerotic patients. Microsurgery 2006; 26 (5) 356-362
- 6 Shestak KC, Jones NF. Microsurgical free-tissue transfer in the elderly patient. Plast Reconstr Surg 1991; 88 (2) 259-263
- 7 Blackwell KE, Azizzadeh B, Ayala C, Rawnsley JD. Octogenarian free flap reconstruction: complications and cost of therapy. Otolaryngol Head Neck Surg 2002; 126 (3) 301-306
- 8 Serletti JM, Higgins JP, Moran S, Orlando GS. Factors affecting outcome in free-tissue transfer in the elderly. Plast Reconstr Surg 2000; 106 (1) 66-70
- 9 Howard MA, Cordeiro PG, Disa J , et al. Free tissue transfer in the elderly: incidence of perioperative complications following microsurgical reconstruction of 197 septuagenarians and octogenarians. Plast Reconstr Surg 2005; 116 (6) 1659-1668 , discussion 1669–1671
- 10 Coskunfirat OK, Chen HC, Spanio S, Tang YB. The safety of microvascular free tissue transfer in the elderly population. Plast Reconstr Surg 2005; 115 (3) 771-775
- 11 Chick LR, Walton RL, Reus W, Colen L, Sasmor M. Free flaps in the elderly. Plast Reconstr Surg 1992; 90 (1) 87-94
- 12 Beausang ES, Ang EE, Lipa JE , et al. Microvascular free tissue transfer in elderly patients: the Toronto experience. Head Neck 2003; 25 (7) 549-553
- 13 Nao EEM, Dassonville O, Chamorey E , et al. Head and neck free-flap reconstruction in the elderly. Eur Ann Otorhinolaryngol Head Neck Dis 2011; 128 (2) 47-51
- 14 Herold C, Gohritz A, Meyer-Marcotty M , et al. Is there an association between comorbidities and the outcome of microvascular free tissue transfer?. J Reconstr Microsurg 2011; 27 (2) 127-132
- 15 Kim HK, Park B, Bae TH, Kim WS. Comparative study of the postoperative complications of microvascular surgery in elderly and young patients. J Reconstr Microsurg 2011; 27 (4) 219-224
- 16 Marshall WH, Fahey PJ. Operative complications and mortality in patients over 80 years of age. Arch Surg 1964; 88: 896-904
- 17 Stephen CR. Risk factors and outcome in elderly patients: an epidemiological study. In: Stephens CR, Assat RAE, , eds. Geriatric Anaesthesia: Principles and Practice. Boston, MA: Butterworth; 1986
- 18 Variakojis RJ, Roizen MF. Preoperative evaluation of the elderly. In: McLeskey CH, , ed. Geriatric Anesthesiology. Baltimore, MD: Williams and Wilkins; 1997: 165-185
- 19 Muravchik S. Anesthesia for the elderly. In: Miller RD, , ed. Anesthesia, 5th ed. Philadelphia, PA: Churchill Livingstone; 2000: 2140-2156
- 20 Spyropoulou GA, Lin PY, Chien CY, Kuo YR, Jeng SF. Reconstruction of the hypopharynx with the anterolateral thigh flap: defect classification, method, tips, and outcomes. Plast Reconstr Surg 2011; 127 (1) 161-172
- 21 Bianchi B, Ferri A, Ferrari S , et al. The free anterolateral thigh musculocutaneous flap for head and neck reconstruction: one surgeon's experience in 92 cases. Microsurgery 2012; 32 (2) 87-95
- 22 Disa JJ, Hidalgo DA. Mandible reconstruction. In: Thorne CH, , ed. Grabb and Smith's Plastic Surgery. Philadelphia, PA: Lippincott Williams and Wilkins; 2007: 428-437
- 23 Carey JN, Watt AJ, Ho O, Zeidler K, Lee GK. Free flap scalp reconstruction in a 91-year-old patient under local-regional anesthesia: case report and review of the literature. J Reconstr Microsurg 2012; 28 (3) 189-193