Morbidity associated with free-tissue transfer after radiotherapy and chemotherapy in elderly cancer patients

Because of their ages and associated medical problems, many elderly cancer patients are treated with radiotherapy and/or chemotherapy to avoid the increased morbidity perceived to occur with prolonged surgical procedures such as tumor resection and reconstruction with free tissue transfer (FTT). The failure of such therapy still often requires tumor resection and reconstruction in irradiated tissue, which may add to the morbidity of surgery. To determine the validity of these concerns, 66 elderly cancer patients who underwent tumor resection and FTT after previous radiotherapy and/or chemotherapy (PT) were compared to a similar group of 64 elderly patients who had not received such previous therapy (NPT). Despite the two groups having similar patient traits, reconstructive-site characteristics, types of flaps used, medical risk factors, and time variables, there were no statistically significant differences between groups for FTT failure (PT 3 percent, NPT 6 percent), medical complication rate (PT 16 percent, NPT 27 percent), surgical complication rate (PT 41 percent, NPT 49 percent), or wound-healing problems. The perioperative mortality rate was 2 percent. The authors conclude, that when medical problems are appropriately corrected before surgery, FTT may be safely performed in elderly patients with a high degree of success, acceptable morbidity, and low mortality. Previous cancer treatment does not appear to predispose elderly patients to a higher rate of FTT failure or wound-healing problems after FTT reconstruction.