Evaluation of the Relationship between Age and Outcome after Microvascular Reconstruction among Patients with Recurrent Head and Neck Squamous Cell Carcinoma

Abstract

In patients with head and neck squamous cell carcinoma (HNSCC), disease recurrence remains a significant obstacle to long-term survival. If possible, surgical salvage with reconstruction remains the best treatment option for patients with recurrence. Currently, there is no literature discussing whether age should preclude microvascular reconstruction in these patients. We hypothesize that older age alone does not affect outcomes. A retrospective chart review of patients with HNSCC at our institution between 2008 and 2015 was performed. Patients were included if they underwent simultaneous resection and flap reconstruction for recurrent HNSCC. Data collected included age, sex, primary site, type of reconstruction, previous treatments, postoperative complications (systemic and reconstructive), and overall survival. A total of 65 patients met inclusion criteria for the review: 42 (64.6%) patients ≤70 years and 23 (35.4%) patients > 70 years. Overall survival was not significantly different between the younger and older groups ( = 0.199). Five-year survival was 60.1% in the younger group and 46.8% in the older group. No significant difference was found in reconstructive complication rates ( = 0.179) or systemic complication rates ( = 0.241) between the two groups. Multivariate logistic regression analysis further showed no significant association between patients' age (≤70 years or > 70 years) and reconstructive complications ( = 0.396) or systemic complications ( = 0.119). Age is not significantly associated with complications among patients undergoing resection and reconstruction for recurrent HNSCC. Microvascular reconstruction remains a feasible option in older patients with recurrent HNSCC. Advanced age alone should not preclude the surgical management of recurrent HNSCC.

Impact of advanced age on microvascular reconstruction of the lower facial third: An American College of Surgeons NSQIP study

“…This is consistent with a number of other studies, and suggests that rather than age, the decision about whether to pursue microvascular head and neck reconstruction should depend on medical comorbidities (Chang et al, ; Ferrari et al, ; Goh et al, ; Patel et al, ; Piazza et al, ; Sugiura et al, ). Medical comorbidities remain the strongest predictor for complications and prolonged hospital length of stay.…”

“…While some have advocated microvascular reconstruction in the older population, no large, multi‐institutional, adequately powered study has been performed before this one (Bhama, Patel, Khan, Bhrany, & Futran, ; Ferrari et al, ; Goh et al, ; Patel et al, ; Piazza et al, ; Sugiura et al, ). One NSQIP study compared outcomes for all microvascular reconstructions by age, but did not differentiate between anatomic regions or control for comorbidities to identify the complications related to age alone (Jubbal, Zavlin, & Suliman, ).…”

Geriatric Patients with Free Flap Reconstruction: A Comparative Clinical Analysis of 256 Cases

“…29 Previous studies demonstrated that free flap transfer is a safe and reliable method of reconstruction of head and neck defects in old or even very old patients. [30][31][32] However, the decision-making process for microvascular reconstruction in the majority of our patients with soft tissue defects in the lower extremity (68.2 and 71.8%, respectively) differs significantly due to a consecutive reduction in blood flow in the vascular system because of a high prevalence of age-related atherosclerosis. In our series, 41% of the very old patients suffered from significant peripheral artery disease, which was more frequently diagnosed in the recent years.…”

The Impact of Age on Perioperative Complications after Extremity Reconstruction with the Free Gracilis Flap: A Retrospective Cohort Study Involving 153 Patients

“…As opposed to advanced age, previous studies revealed that higher ASA scores between III and IV correlated significantly with increased postoperative medical and flaprelated complications. 10,[24][25][26][27][28][29] Our data suggests that the occurrence of overall flap complications correlates significantly with higher age (p ¼ 0.009) and a higher ASA score (0.024). Our results revealed that, with every year of life, the risk of an overall flap complication is 1.035 times higher than the year before.…”

“…According to the majority of studies on microsurgery in elderly patients, there is no correlation between advanced age and surgical outcome itself or flap success. 9,10,13,[25][26][27][28][29] Most reports could not find a correlation between higher age and a higher risk of partial or complete flap failure, or other surgical complications. Only one recent study by Klein et al, 30 which exclusively analyzed patients aged above 80 years, found higher flap failures up to 11% in elderly patient collectives compared with other studies.…”