Comorbidities Are Not Contraindications to Free Flap Reconstruction in Elderly Patients with Advanced Head and Neck Cancer

Öz

Introduction Elderly patients with advanced head and neck cancer are often managed with non-surgical treatments due to concerns about comorbidities and perioperative risk, which may result in suboptimal quality of life. This study evaluates the feasibility of surgical excision and free flap reconstruction in this population. Methods We included 19 patients aged ≥70 years with comorbidities who underwent surgical excision and free flap reconstruction between 2007 and 2024. Data on tumor characteristics, flap type and size, comorbidities, ASA and CCI scores, postoperative outcomes, and follow-up were analyzed. Results All patients had stage III–IV head and neck tumors. Reconstructions were performed using various free flaps, most commonly anterolateral thigh flap (ALT) and radial forearm flap (RFF). The mean age was 75.3 years. Hypertension [n=17] and diabetes [n=9] were the most common comorbidities. The mortality rate was 21%. Flap loss occurred in one patient, yielding a flap success rate of 94.7%. Higher ASA and CCI scores were observed in patients who died; however, this was not statistically significant. The mean follow-up period was 13 months. Conclusions Free flap reconstruction is feasible in elderly patients with advanced head and neck cancer. Advanced age and comorbidities alone should not be considered contraindications. Treatment decisions should prioritize quality of life and incorporate patient preference.

Anahtar Kelimeler

• Head and neck cancer
• Elderly patients
• Free flap reconstruction
• Microvascular surgery
• Comorbidity

Komorbidite, İleri Evre Baş-Boyun Kanseri Olan Yaşlı Hastalarda Serbest Flep Rekonstruksiyonu İçin Kontraendikasyon Değildir

Öz

Giriş İleri evre baş-boyun kanseri olan yaşlı hastalar, komorbiditeler ve perioperatif risklerden dolayı sıklıkla cerrahi dışı tedavilerle yönetilmektedir ve bu durum yaşam kalitesinde düşmeye yol açabilmektedir. Bu çalışma, bu hasta grubunda cerrahi eksizyon ve serbest flep rekonstrüksiyonunun uygulanabilirliğini değerlendirmektedir. Yöntem 2007–2024 yılları arasında cerrahi eksizyon ve serbest flep rekonstrüksiyonu uygulanan ve komorbiditesi bulunan 70 yaş ve üzeri 19 hasta çalışmaya dahil edildi. Tümör özellikleri, flep tipi ve flebin boyutu, komorbiditeler, ASA ve CCI skorları, postoperatif sonuçlar ve takip süresi verileri analiz edildi. Bulgular Tüm hastalarda evre III–IV baş-boyun tümörü mevcuttu. Rekonstrüksiyon çeşitli serbest flepler kullanılarak gerçekleştirildi; en sık kullanılan flepler anterolateral uyluk flebi (ALT) ve radial önkol flebi (RFF) idi. Hastaların yaş ortalaması 75,3 idi. En sık görülen komorbiditeler hipertansiyon (n=17) ve diyabet (n=9) idi. Mortalite oranı %21 olarak bulundu. Bir hastada flep kaybı meydana geldi ve flep başarı oranı %94,7 olarak hesaplandı. Ölen hastaların ASA ve CCI skorları daha yüksek olmasına rağmen bu fark istatistiksel olarak anlamlı değildi. Ortalama takip süresi 13 aydı. Sonuç Serbest flep rekonstrüksiyonu, ileri evre baş-boyun kanseri olan yaşlı hastalarda uygulanabilir bir yöntemdir. İleri yaş ve komorbiditeler tek başına kontrendikasyon olarak değerlendirilmemelidir. Tedavi kararı verilirken yaşam kalitesi ön planda tutulmalı ve hasta tercihleri dikkate alınmalıdır.

Anahtar Kelimeler

• Baş-boyun kanseri
• yaşlı hastalar
• serbest flep rekonstrüksiyonu
• mikrovasküler cerrahi
• komorbidite

Kaynakça

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