Department of Otolaryngology-Head and Neck Surgery, Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France.
Clinical Research Center, Croix Rousse Hospital, Hospices Civils de Lyon, Lyon, France; Cancer Research Center of Lyon, UMR Inserm U1052, CNRS 5286, Lyon, France; Claude Bernard University, Lyon 1, France.
J Geriatr Oncol. 2019 Jul;10(4):577-583. doi: 10.1016/j.jgo.2018.11.002. Epub 2018 Nov 27.
The main purpose of this study was to evaluate the perioperative morbidity of free flap head and neck reconstructive surgery in patients aged 70 years and over (Group A) by comparison with a cohort of younger patients (Group B). Secondary objectives included assessment of survival rates and functional outcomes in these older patients, likewise by comparison with a cohort of younger patients.
A retrospective study was conducted on all patients aged 70 years and over who underwent free flap reconstruction between 2012 and 2017. They were compared to a control group of younger patients to investigate hospital length of stay, postoperative complications and survival rates, and functional outcomes.
No significant difference was observed between the two groups in terms of variables such as hospital length of stay and medical/surgical complications. In multivariate analysis, comorbidity was the only predictive factor for postoperative medical complications, and pharyngolaryngeal location the only significant predictive factor for surgical complications. Factors significantly associated with hospital length of stay were older age, active smoking, pharyngolaryngeal location and the Charlson Comorbidity Index (CCI). Overall survival was the only factor that was substantially lower in the over 70 group, while disease-specific and relapse-free survival were comparable in both groups.
Old age per se should not be considered a contraindication to major surgery combined with free flap reconstruction in older patients.
本研究的主要目的是通过比较年龄较大患者（A 组）和年轻患者（B 组）的围手术期发病率，评估 70 岁及以上患者行游离皮瓣头颈部重建手术的围手术期发病率。次要目的包括评估这些老年患者的生存率和功能结局，并与年轻患者进行比较。
对 2012 年至 2017 年间行游离皮瓣重建的所有 70 岁及以上患者进行回顾性研究。将其与年轻患者的对照组进行比较，以调查住院时间、术后并发症和生存率以及功能结局。
两组在住院时间和医疗/手术并发症等变量方面无显著差异。多变量分析显示，合并症是术后医疗并发症的唯一预测因素，咽喉位置是手术并发症的唯一显著预测因素。与住院时间显著相关的因素是年龄较大、主动吸烟、咽喉位置和 Charlson 合并症指数（CCI）。70 岁以上组的总体生存率显著降低，而疾病特异性生存率和无复发生存率在两组之间无显著差异。
年龄本身不应被视为老年患者行重大手术联合游离皮瓣重建的禁忌症。
