Perioperative managementof patients undergoing head and neck cancer resection and reconstruction with free flaps

PURPOSE OF REVIEW: Patients with head and neck cancer tend to be older, frailer and have more comorbidities than the general surgical population and frequently necessitate wide resections requiring complex reconstructions with free flaps. Preoptimization approaches, airway management protocols, intraoperative fluid administration, blood pressure goals, and use of pressors have been extensively evaluated, and while consensus has been substantially achieved on previously controversial aspects such as intraoperative use of vasopressors, standardized approaches to perioperative care are still evolving. RECENT FINDINGS: Recent literature has focused on perioperative optimization and enhanced recovery pathways, especially in the care of frail and elderly patients. Airway management in adults and children and optimization of pain management to cover multilocalized pain (resection and free tissue donor site) have been additional topics of interest, as well as the value and applicability of risk scores for postoperative complications and predictive models of delayed recovery. SUMMARY: The perioperative management of reconstructive head and neck cancer surgery presents unique challenges. The prevalence of frailty, elevated comorbidity burden and high-risk airway management in this patient population, combined with the complexity of the procedures, require careful individualized planning and specialized care.