Momeni Arash, Kim Rebecca Y, Kattan Ahlia, Lee Gordon K
From the Divisions of *Plastic and Reconstructive Surgery, and †General Surgery, Stanford University Medical Center, Palo Alto, CA.
Ann Plast Surg. 2013 Apr;70(4):462-9. doi: 10.1097/SAP.0b013e31827737a5.
Evaluation of quality of life (QOL) measures is increasingly being valued as an essential parameter to determine treatment results after head and neck reconstruction. The present study was designed to evaluate the effect of microsurgical reconstruction on patient-reported QOL.
Patients undergoing microsurgical reconstruction after radical oncosurgical ablation of head and neck malignancies from March 2007 to March 2010 were included in the study. To assess health-related QOL, the following questionnaires were sent to patients who met inclusion criteria: European Organization for Research and Treatment of Cancer (EORTC) Core Quality of Life Questionnaire (QLQ-C30 [Version 3.0]) and Head and Neck Cancer Quality of Life Questionnaire (QLQ-H and N35).
A total of 60 patients underwent microsurgical reconstruction of postablative head and neck defects during the study period. Twenty-one patients were successfully contacted, all of which completed the surveys. Satisfactory global QOL scores were achieved. Advanced age correlated with greater impairment for the ability to taste and smell (P = 0.05). Radiotherapy seemed to be associated with "sticky saliva"; although this was not statistically significant (P = 0.06). Recurrent disease at the time of surgical ablation and microsurgical reconstruction did not seem to have any appreciable impact on QOL. Finally, patients who developed postoperative complications had lower levels of "cognitive functioning" (P = 0.04), problems with "insomnia" (P = 0.04) and "social contact" (P = 0.03), and more commonly "felt ill" (P = 0.03).
Improved global QOL scores were observed after microsurgical reconstruction of various head and neck defects when compared to reported pretreatment scores. Of the parameters analyzed, it seems that postoperative complications have the most profound effect on items assessed with the EORTC QLQ-C30 and H and N35 surveys. Our findings provide further scientific evidence that patients with head and neck malignancy benefit from surgical intervention with respect to postoperative QOL.
生活质量（QOL）评估作为确定头颈部重建术后治疗效果的重要参数，其重要性日益受到重视。本研究旨在评估显微外科重建对患者报告的生活质量的影响。
纳入2007年3月至2010年3月期间因头颈部恶性肿瘤接受根治性肿瘤手术切除后进行显微外科重建的患者。为评估与健康相关的生活质量，向符合纳入标准的患者发送了以下问卷：欧洲癌症研究与治疗组织（EORTC）核心生活质量问卷（QLQ-C30 [第3.0版]）和头颈部癌生活质量问卷（QLQ-H和N35）。
在研究期间，共有60例患者接受了头颈部缺损切除术后的显微外科重建。成功联系到21例患者，所有患者均完成了调查。获得了令人满意的总体生活质量评分。高龄与味觉和嗅觉能力的更大损害相关（P = 0.05）。放疗似乎与“唾液黏稠”有关；尽管这在统计学上不显著（P = 0.06）。手术切除和显微外科重建时的复发性疾病似乎对生活质量没有任何明显影响。最后,发生术后并发症的患者“认知功能”水平较低（P = 0.04），存在“失眠”（P = 0.04）和“社交接触”问题（P = 0.03），并且更常“感觉不适”（P = 0.03）。
与术前报告的评分相比，对头颈部各种缺损进行显微外科重建后，总体生活质量评分有所提高。在所分析的参数中，术后并发症似乎对EORTC QLQ-C30和H及N35调查评估的项目影响最为深远。我们的研究结果提供了进一步的科学证据，表明头颈部恶性肿瘤患者在术后生活质量方面受益于手术干预。
