Comorbidity measured with ACE-27 was a prognostic factor for overall survival in patients older than 70 years with head and neck cancer. The Karnofsky performance index could be included in multivariable analysis of survival for older patients with head and neck cancer.

Background. Pectoralis major and other myofascial/myocutaneous flaps have been recognized as important reconstructive methods in head and neck cancer surgery. Even with the worldwide use of free flaps, they are still the mainstay reconstructive procedures in many centers.Methods. We retrospectively analyzed the records of patients with head and neck cancer who underwent an immediate reconstruction with pectoralis major or other myofascial/myocutaneous flaps at a tertiary cancer center from 1982 to 1998.Results. A total of 437 patients were reviewed. Three hundred seventy-one patients underwent pectoralis major myocutaneous flaps; of these, 335 (90.3%) were men, with a median age of 56 years (range, 24 -91 years). Tumors were located at the oral cavity and oropharynx in 246 patients (66.3%). Most tumors were at an advanced stage at presentation (T3 -T4 in 60.9%). The flaps were used to cover mucosal defects in 280 patients (75.5%), skin defects in 62 patients (16.7%), and both in 29 patients (7.8%). In most patients, the flap was transferred to the head and neck region through a subclavicular tunnel. The overall complication rate was 36.1%, with 2.4% of cases involving total flap necrosis. Conclusion.To date, this is the largest published series of patients who underwent reconstruction with a pectoralis major flap. Our results show that this flap remains an important reconstructive method, and it can be done with low risk and acceptable morbidity.

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Salvage surgery can be performed with acceptable rates of postoperative complications. The clinical stage of the recurrent tumor and the previous site treated were the 2 major factors associated with the occurrence of postoperative complications.

Selection of substandard treatment decreases overall and cancer-specific survival. Selecting substandard treatment for reasons such as chronologic age, tumor site, or moderate or mild comorbidities worsen patient prognosis.