How to select candidates for microvascular head and neck reconstruction in the elderly? Predictive factors of postoperative outcomes

The proportion of elderly patients with head and neck cancer is increasing. However, predictive factors of postoperative outcomes are insufficiently explored in this population. In this study, we aimed to determine predictive factors of postoperative outcomes in elderly patients undergoing head and...

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Published in:Surgical oncology 2020-09, Vol.34, p.168-173
Main Authors: D'Andréa, Grégoire, Scheller, Boris, Gal, Jocelyn, Chamorey, Emmanuel, Château, Yann, Dassonville, Olivier, Poissonnet, Gilles, Culié, Dorian, Koulmann, Pierre-Henri, Hechema, Raphaël, Demard, François, Elaldi, Roxanne, Bozec, Alexandre
Format: Article
Language:English
Subjects:
Age
Comorbidity
Complications
Defects
Elderly
Enteral nutrition
Failure
Free-flap
Geriatrics
Head & neck cancer
Head and neck cancer
Medical records
Microvasculature
Multivariate analysis
Nutrition research
Older people
Ostomy
Patients
Pharynx
Plastic surgery
Population studies
Postoperative period
Questionnaires
Reconstructive surgery
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Summary:The proportion of elderly patients with head and neck cancer is increasing. However, predictive factors of postoperative outcomes are insufficiently explored in this population. In this study, we aimed to determine predictive factors of postoperative outcomes in elderly patients undergoing head and neck free-flap reconstructive surgery in order to determine criteria on which patient selection could be based. All patients aged 65 years or over who underwent head and neck free-flap reconstructive surgery at our institution, between 2000 and 2016, were included in this retrospective study. Predictive factors of postoperative outcomes were investigated in uni- and multivariate analysis. Two-hundred patients were included in the study. Older age (>70, >75 or > 80 yrs) had no significant impact on postoperative outcomes. Free flap failure local and general complications rates were 11%, 34% and 43%, respectively. Oromandibular reconstruction (p = 0.04) was significantly associated with free flap failure and salvage surgery (p = 0.04) with local complications. A high comorbidity level (Charlson Comorbidity Index score ≥ 4; p = 0.02) was associated with a higher risk of general complications. A G8 (Geriatric 8 questionnaire) score 
ISSN:0960-7404
1879-3320
DOI:10.1016/j.suronc.2020.04.016