The impact of frailty on adjuvant treatment in patients with head and neck free flap reconstruction-a retrospective study using two independent frailty scores: avoiding the wrong conclusion

The recently published retrospective study by H. P. Shah et al. aimed to investigate the impact of frailty on time to initiation, duration, and completion of adjuvant treatment after free flap reconstructive surgery for head and neck cancers. On multivariate analyses, the authors found a significant delay in adjuvant treatment initiation in frail patients according to the mFI score compared to non-frail ones. Also, their results showed that frailty may be associated to a lack of completion of postoperative radiotherapy and chemotherapy. However, the fact that these findings are presented with reference to free flap reconstruction may be misleading concerning the possible conclusions of their study. First, in the introduction section of the article it is suggested that because reconstructive surgery may result in a prolonged post-surgical course, it might impact initiation of adjuvant therapy. However, this statement is not supported with any evidence from the literature. On the contrary, various published studies have demonstrated that free tissue transfer in frail patients is not associated with a higher complication rate nor to a longer hospital stay, both compared to non-frail patients and to frail ones undergoing reconstruction with regional flaps.