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

Abstract

IntroductionElderly 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.MethodsWe 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.ResultsAll 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.ConclusionsFree 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.