Third Repeat Microvascular Reconstruction in Head and Neck Cancer Patients Aged 65 Years and Older: A Longitudinal and Sequential Analysis

Abstract

Performing a sequential third free flap for reconstruction of a head and neck defect after cancer resection can be challenging, and the problem is further compounded in elderly patients. The outcomes in this clinical scenario are currently unknown and this study aims to compare the results in elderly patients with younger patients in a high-volume microsurgical unit. A retrospective review of 126 consecutive patients who had undergone three sequential free flap reconstructions after head and neck cancer was performed. The patients were divided into two groups – older or younger than 65 years old (n = 105 and n = 21, respectively). Patient demographics, intraoperative and postoperative outcomes were noted and analyzed. The overall flap success in this patient cohort was 94.4% (7 flap losses in 126 patients). Cardiovascular complications were significantly more common in the older group (19% vs. 1.9%, p = 0.001). Delirium occurred more frequently in the older group compared with the younger group (23.8% vs. 6.7%, p = 0.023). There were no significant differences regarding surgical complications. With adequate planning, a sequential third free flap can be performed safely and successfully in patients who are more than 65 years of age. Particular attention to the perioperative morbidity in elderly patients is crucial for successful outcomes.

Incidence of Postoperative Delirium in Cancer Patients After Head and Neck Surgery: A Proportional Meta‐analysis

“…Four of the included studies were prospective cohort studies, and 1 was RCTs. 24 Twenty-four studies were conducted in Asia (11 in Japan, 21,22,[25][26][27]32,34,35,39,40,42 3 in China, 8,24,44 2 in South Korea, 23,30 and 1 in Taiwan 33 ), 6 in North America (all 6 in the United States 4,28,29,38,41,43 ), and 4 in Europe (3 in Germany 31,36,37 and 1 in Scotland 12 ). The sample sizes of the studies ranged from 30 to 1006 participants, the proportion of male participants ranged from 51% to 99.1%, and the mean age of the participants ranged from 54.9 to 73.7 years.…”

“…Table 1 summarizes the details of the process of identifying POD. 21,23,25,26,30,33,38,41 male sex, 4,37,39 smoking/tobacco use, 4,12,35 excess alcohol consumption, 12,39,41 advanced cancer stage, 8 history of neurological and psychiatric disorder, 23,30 pre-existing symptoms and comorbidities (cognitive impairment, 23,38,41 and advanced nodal disease 4 ), preoperative factors (higher ASA score 8,23 and higher albumin level 34,35,39 ), prolonged duration of surgery, 4,12,26,38,42 increased length of stay, 23 duration of ventilation, 37 the requirement of tracheostomy, 12,36 fluid imbalance, 12,25,37 longer sedation period, 27 and postoperative complications (pain 23 and insomnia 34,35 ) were reported as risk factors for the incidence of POD.…”