Free tissue transfer in patients over 75 with head and neck malignancy

Radical excision and reconstruction, often with free tissue transfer, has been shown to offer the best hope of cure for advanced head and neck malignancy.:Despite the fact that these patients are often elderly, with significant preoperative morbidity there have been few, if any, reports of the success of excision and free tissue reconstruction in patients over 75 years old. We therefore performed a consecutive review of 12 patients over 75 undergoing such surgery in this unit over the past three years in an effort to clarify indications, success rate anti complications. The age of the patients ranged from 75 to 88 years (mean 81). All of the flaps survived. Two (16%) required early reexploration. Six of the twelve (50%) patient remain tumour free an average of 18.3 months after surgery (range 1-33 months). One died of causes unrelated to his tumour 14 months after surgery. Of the remaining five, two died in the early post-operative period, two of recurrent tumour or a second primary and one remains alive 8 months post-surgery despite local reccurrence. We dicuss the indications, complications and outcomes of surgery in these cases and discuss patient selection and measures which may help reduce peri-operative morbidity and mortality in these elderly patients undergoing radical surgery.