Advanced patient age should not preclude the use of free-flap reconstruction for head and neck cancer

Microvascular free flaps have become the principal form of reconstruction after the radical excision of head and neck malignancies at Royal Prince Alfred Hospital, Sydney. This surgery is time consuming, complex, and may be regarded as inappropriate in some elderly patients. This paper examines whether or not elderly patients (aged 70 years and older) are unduly disadvantaged by this form of reconstruction in the management of head and neck malignancy.

Two groups of patients were retrospectively studied: 26 patients aged 70 years or older (group 1) and 91 patients aged less than 70 years (group 2). All patients had a free-flap reconstruction after radical excision of head and neck malignancies between 1987 and 1993. The anatomic distributions of cancers and clinical stages were similar in both groups. The two groups were examined for preoperative medical risk factors, postoperative complications, length of hospital stay, and ability to tolerate an oral diet.

In group 1, 81% of patients had at least 1 preoperative risk factor, with 42% cardiac and 27% respiratory risks. In group 2, 51% of patients had preoperative risks, 11% cardiac and 22% respiratory. Postoperatively, 42% of patients in group 1 had surgical complications, versus 37% in group 2. Postoperative medical complications were 54% in group 1 and 29% in group 2. Median hospital stay was 22 and 23 days, respectively.

There was no statistical difference in the postoperative surgical complication rates, and, when stratified for premorbid factors, the overall postoperative complication rates between the two groups were also not statistically significantly different. This suggests that age alone should not exclude a patient from radical surgery for head and neck cancer with free-flap repair.