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Comparative Study
. 2012 Dec;32(6):371-5.

Head and neck cancer in elderly patients: is microsurgical free-tissue transfer a safe procedure?

A Tarsitano  1 , A Pizzigallo, R Sgarzani, C M Oranges, R Cipriani, C Marchetti
Affiliations
Comparative Study

Head and neck cancer in elderly patients: is microsurgical free-tissue transfer a safe procedure?

A Tarsitano et al. Acta Otorhinolaryngol Ital. 2012 Dec.

Abstract
in English, Italian

The safety and success of microvascular transfer have been well documented in the general population, but the good results achieved with the use of free flaps in elderly patients have received little attention. This study sought to identify differences in complications, morbidity and functional outcomes between elderly (≥ 75 years) and younger (< 75 years) patients treated surgically for advanced head and neck cancer using the Head and Neck 35 module of the European Organisation for Research and Treatment of Cancer quality of life questionnaire. Patient treatment consisted of composite resection, including excision of the primary tumour with ipsilateral or bilateral neck dissection and microvascular reconstruction. Eighty-five microvascular tissue transfers were performed to reconstruct major surgical defects. Postoperative radiation therapy was performed when indicated. Total flap loss occurred in three cases in elderly patients and two cases in younger patients. The rates of major surgical complication were 9% in young patients and 11% in elderly patients. No significant difference was observed between the two groups in the rates of major and minor flap complications, morbidity or long-term functional outcome. The results of the present analysis indicate that free-flap microvascular reconstruction can be considered a safe procedure in elderly patients with head and neck cancer.

RIASSUNTOSebbene la sicurezza ed il successo delle procedure ricostruttive microvascolari del distretto cervicofacciale siano state ben analizzate e documentate nella letteratura medica recente, non altrettatanto è accaduto per le procedure microchirurgiche nella popolazione anziana. Questo studio si prefigge lo scopo di valutare se esistano differenze, in termini di complicanze, morbidità e funzione, in due popolazioni di pazienti: giovani-adulti (< 75 anni) ed anziani (≥ 75 anni), sottoposti a trattamento chirurgico microvascolare per tumori avanzati del distretto testa-collo. Il trattamento è consistito nella chirurgia resettiva tumorale associata a dissezione linfonodale del collo ipsi o bilaterale e ricostruzione mediante il trasferimento microchirurgico di un lembo libero. Nella popolazione di pazienti in analisi 85 lembi liberi sono stati effettuati. La terapia radiante adiuvante è stata effettuata, quando necessaria, in funzione dello stadio di malattia. La perdita completa del lembo si è verificata in 3 casi nel gruppo di pazienti anziani ed in 2 casi nei pazienti giovani-adulti. La percentuale di complicanze maggiori è risultata essere del 9% nei pazienti giovani e del 11% nei pazienti anziani. Non sono emerse differenze statisticamente significative in termini di complicanze maggiori e minori legate al lembo, morbidità e risultati funzionali a lungo termine. In conclusione, dai nostri dati è possibile desumere che la chirurgia ricostruttiva microvascolare del distretto cervicofacciale possa essere considerata una procedura affidabile anche nel paziente anziano.

Keywords: Complication; Elderly patient; Functional outcome; Head and neck cancer; Microvascular free flap.

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Figures

Fig. 1.
Fig. 1.
Age distribution in the elderly patient group.
Fig. 2.
Fig. 2.
Age distribution in the young patient group.
Fig. 3.
Fig. 3.
Histological tumour types.
See this image and copyright information in PMC

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