Postoperative complications in elderly patients after resection of head and neck cancers and reconstruction with microvascular free flap transfer

Background
Aging and its related medical comorbidities may aggravate postoperative complications after resection of head and neck cancers (HNC) and concomitant reconstruction of the resectional defect by microvascular free flap transfer (MFFT).
Patients and methods
Medical records of adult patients who had oncologic resection of HNC and reconstructive MFFT at Sohag University Hospital (February 2013–January 2019) were analyzed. Severity of postoperative complications (medical, recipient site, and donor site) was ranked according to Clavien-Dindo system and compared between elderly group (≥65 years) and matching control group of nonelderly (<65 years) patients.
Results
A total of 32 patients were enrolled (20 males and 12 females), with an age range of 36–78 years. MFFT was applied for reconstruction of 22 soft tissue and 10 oromandibular defects following complete tumor resection. Considering medical and surgical complications collectively, elderly patients exhibited significantly higher grades of complications (=0.01). Specifically, medical complications were significantly increased (=0.03) in the elderly group. Free flap losses occurred in two elderly patients compared with one nonelderly patient. However, there was no significant difference between both groups in surgical complications, neither at the recipient nor the donor sites. Likewise, no significant increase in operative time or intraoperative blood transfusion was observed among elderly in comparison with their nonelderly controls. Elderly patients required significantly prolonged hospital stay (=0.03), likely owing to their increased medical complications.
Conclusions
Concomitant resection of HNC and MFFT reconstruction can be safely performed only in carefully selected elderly patients who have no or adequately controlled medical comorbidities.