Abstract
Demographic changes strongly affect industrialized countries. While free tissue transfer was initially believed to be beneficial only for younger patients, there is an increasing number of elderly patients requiring microvascular operations in our aging society. Medical and surgical risks for head and neck cancer patients over a certain age who undergo free tissue transfer has hardly been investigated. A retrospective mono-center cohort study was performed. All patients with the age 75 or higher undergoing microvascular operations were reviewed. Patient characteristics including the ASA-status, the ACE-27-score, flap survival and postoperative medical and surgical complications were evaluated. The Clavien–Dindo-classification system for postoperative complications was applied to assess the severity of the complications. A total of 31 patients with an average age of 78.8 years were included. 4 patients suffered from venous congestion and had to undergo revision surgery. All flaps could successfully be salvaged. Higher ASA-status and ACE-score were significantly associated with postoperative medical and surgical complications and a higher severity of the complications. However , neither age nor operating time had influence on the complication rate. Microvascular free tissue transfer can be performed with a high degree of security in selected elderly patients. However, serious medical complications remain a concern, correlating strongly with high ASA and ACE-score. Careful patient selection is mandatory to reduce complications to a minimum.
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References
Hayden RE, Nagel TH (2013) The evolving role of free flaps and pedicled flaps in head and neck reconstruction. Curr Opin Otolaryngol Head Neck Surg 21:305–310
Wu CC, Lin PY, Chew KY, Kuo YR (2013) Free tissue transfers in head and neck reconstruction: complications, outcomes and strategies for management of flap failure: analysis of 2019 flaps in single institute. Microsurgery 34:339–344
Heidekrueger PI, Heine-Geldern A, Ninkovic M, Herter F, Schmauss D, Aung T, Broer PN (2016) Microsurgical reconstruction in patients greater than 80 years old. Microsurgery. doi:10.1002/micr.30132
Klein HJ, Fuchs N, Mehra T, Schweizer R, Giesen T, Calcagni M, Huber GF, Giovanoli P, Plock JA (2016) Extending the limits of reconstructive microsurgery in elderly patients. J Plast Reconstr Aesthet Surg 69:1017–1023
Tarsitano A, Pizzigallo A, Sgarzani R, Oranges CM, Cipriani R, Marchetti C (2012) Head and neck cancer in elderly patients: is microsurgical free-tissue transfer a safe procedure. Acta Otorhinolaryngol Ital 32:371–375
Dimovska EO, Clibbon JJ, Moncrieff MD, Heaton MJ, Figus A (2016) Microsurgical reconstructions for head and neck cancers in elderly aged >80 years: an analysis of surgical outcomes and quality of life. Ann Surg Oncol 23:1684–1692
Bonawitz SC, Schnarrs RH, Rosenthal AI, Rogers GK, Newton ED (1991) Free-tissue transfer in elderly patients. Plast Reconstr Surg 87:1074–1079
Howard MA, Cordeiro PG, Disa J, Samson W, Gonen M, Schoelle RN, Mehrara B (2005) Free tissue transfer in the elderly: incidence of perioperative complications following microsurgical reconstruction of 197 septuagenarians and octogenarians. Plast Reconstr Surg 116:1659–1668 (discussion 1669)
Baumeister P, Rauch J, Jacobi C, Kisser U, Betz C, Becker S, Reiter M (2017) Impact of comorbidity and anemia in patients with oropharyngeal cancer primarily treated with surgery in the human papillomavirus era. Head Neck 39:7–16
Borggreven PA, Kuik DJ, Quak JJ, De Bree R, Snow GB, Leemans CR (2003) Comorbid condition as a prognostic factor for complications in major surgery of the oral cavity and oropharynx with microvascular soft tissue reconstruction. Head Neck 25:808–815
Klenk J, Rapp K, Büchele G, Keil U, Weiland SK (2007) Increasing life expectancy in Germany: quantitative contributions from changes in age- and disease-specific mortality. Eur J Public Health 17:587–592
Koruda MJ, Sheldon GF (1991) Surgery in the aged. Adv Surg 24:293–331
Buhre W, Rossaint R (2003) Perioperative management and monitoring in anaesthesia. Lancet 362:1839–1846
Markey J, Knott PD, Fritz MA, Seth R (2015) Recent advances in head and neck free tissue transfer. Curr Opin Otolaryngol Head Neck Surg 23:297–301
Hayden RE (2014) Editorial: head and neck reconstruction. Curr Opin Otolaryngol Head Neck Surg 22:399–400
Perrot P, Le Floch R, Bellier-Waast F, Bourdais L, Pannier M, Duteille F (2008) Free-flap reconstruction in the elderly patient. Ann Chir Plast Esthet 53:420–423
Ozkan O, Ozgentas HE, Islamoglu K, Boztug N, Bigat Z, Dikici MB (2005) Experiences with microsurgical tissue transfers in elderly patients. Microsurgery 25:390–395
Kim H, Kim SD, Shim YJ, Lee SY, Sung MW, Kim KH, Hah JH (2016) Is there any age cutoff to treat elderly patients with head and neck cancer? Comparing with septuagenarians and octogenarians. J Korean Med Sci 31:1300–1306
Kruse AL, Luebbers HT, Grätz KW, Obwegeser JA (2010) Factors influencing survival of free-flap in reconstruction for cancer of the head and neck: a literature review. Microsurgery 30:242–248
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Reiter, M., Baumeister, P. & Jacobi, C. Head and neck reconstruction in the elderly patient: a safe procedure?. Eur Arch Otorhinolaryngol 274, 3169–3174 (2017). https://doi.org/10.1007/s00405-017-4599-3
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DOI: https://doi.org/10.1007/s00405-017-4599-3