Free Flaps for Advanced Oral Cancer in the "Older Old" and "Oldest Old": A Retrospective Multi-Institutional Study
Free Flaps for Advanced Oral Cancer in the "Older Old" and "Oldest Old": A Retrospective Multi-Institutional Study
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DOI：
10.3389/fonc.2019.00604
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发表时间：
2019-07-03
影响因子：
4.7
通讯作者：
Nicolai, Piero
中科院分区：
文献类型：
--
作者：
Grammatica, Alberto;Piazza, Cesare;Nicolai, Piero
前言：手术后辅助治疗是晚期口腔鳞状细胞癌（OSCC）最有效的治疗方法。游离皮瓣被认为是口腔大手术后最好的重建选择。在过去的几十年中，由于寿命的延长，老年人的OSCC有所增加。这项工作的目的是评估75岁以上患者的微血管手术的可行性，重点是临床和外科prosticators.Methods：“老年人”（年龄>= 75）和“最老的老”（>85）谁接受了微血管重建的口腔鳞癌从2002年至2018年的三个转诊头颈部的患者进行了回顾性评价。收集并分析人口统计学、临床和手术数据。采用阿萨和ACE-27评分进行术前评估。结果：84例患者（72例“高龄老人”，12例“高龄老人”），游离皮瓣成功率为94.1%。分别有37例（44.7%）和9例（10.7%）患者发生轻微和严重医学并发症;分别有18例（21.4%）和17例（20.2%）患者发生轻微和严重手术并发症。21例（25%）患者同时发生内科和外科并发症（具有统计学显著相关性，p = 0.018）。总体而言，52例（61.9%）患者至少有一个并发症：阿萨评分，糖尿病，全身麻醉（DGA）的持续时间显着影响并发症发生率在多变量analysis.Conclusion：我们的数据证实了在适当选择的老年患者的口腔鳞状细胞癌重建游离皮瓣的可行性。术前评估和积极的管理，糖尿病患者的糖尿病是强制性的。应尽可能减少DGA，以防止术后并发症。综合老年评估是至关重要的，在这一子集的患者。
Introduction: Surgery followed by adjuvant therapy represents the most adequate treatment for advanced oral squamous cell carcinoma (OSCC). Free flaps are considered the best reconstructive option after major oral surgery. In the last decades, OSCC has increased in the elderly due to an augmented life span. The aim of this work is to evaluate the feasibility of microvascular surgery in patients older than 75 years, focusing on clinical and surgical prognosticators.Methods: "Older old" (aged >= 75) and "oldest old" (>85) patients who underwent microvascular reconstruction for OSCC from 2002 to 2018 were retrospectively evaluated in three referral Head and Neck Departments. Demographic, clinical, and surgical data were collected and analyzed. Pre-operative assessment was performed by ASA and ACE-27 scores. Complications were grouped as medical or surgical, an d major or minor according to the Clavien-Dindo scale.Results: Eighty-four patients (72 "older old" and 12 "oldest old") were treated with a free flap success rate of 94.1%. Thirty-seven (44.7%) and nine (10.7%) patients had minor and major medical complications, respectively; 18 (21.4%) and 17 (20.2%) had minor and major surgical complications, respectively. Twenty-one (25%) patients had both medical and surgical complications (with a statistically significant association, p = 0.018). Overall, 52 (61.9%) patients had at least one complication: ASA score, diabetes mellitus, and duration of general anesthesia (DGA) significantly impacted the complication rate at multivariate analysis.Conclusion: Our data confirm the feasibility of free flaps for OSCC reconstruction in appropriately selected elderly patients. Pre-operative assessment and aggressive management of glycemia in patients with diabetes is mandatory. DGA should be reduced as much as possible to prevent post-surgical complications. Comprehensive geriatric assessment is of paramount importance in this subset of patients.