Borges-Santos Erickson, Rodrigues Telma Ribeiro, Lira Renan Bezerra, Kulcsar Marco Aurelio Vamondes, Kowalski Luiz Paulo
Oncology Postgraduate Program, University of São Paulo Medical School, São Paulo, Brazil.
Head and Neck Surgery and Otorhinolaryngology Department, A. C. Camargo Cancer Center, São Paulo, Brazil.
Gland Surg. 2024 Apr 29;13(4):490-499. doi: 10.21037/gs-23-471. Epub 2024 Apr 10.
Neck dissection performed via retroauricular approach emerged as an alternative to the conventional approach, aiming to maintain therapeutic efficacy with lower postoperative morbidity. Differences among these modalities in terms of functional aspects and quality of life (QOL) remains unclear. This study aims to evaluate the anatomical and functional aspects and the QOL in patients undergoing unilateral neck dissection via conventional or retroauricular (endoscopic or robotic) access.
This study involved consecutively 35 patients who underwent unilateral neck dissection for head and neck cancer, 25 submitted to the conventional surgery [conventional group (CG)] and 10 to the retroauricular approach [retroauricular group (RG)]. Patients were evaluated preoperatively and on the 30 postoperative day (POD) regarding range of motion (ROM) of the cervical spine and shoulder, trapezius muscle strength and QOL.
The CG and RG were similar in terms of anthropometric, clinical and surgical variables. The mean age of both groups was between 52 and 55 years old. There was a predominance of females in the CG (52%) and males in the RG (70%); P=0.08. The most affected site was the oropharynx followed by the thyroid in the two groups and the most frequently dissected levels were I-III in both groups. There was a difference in the length of hospital stay {CG: 5 [1-22] days and RG: 2 [1-6] days; P=0.02} and pain scores at the 30 POD was higher in CG group (P=0.002). Regarding the cervical spine ROM, it was better in RG in the 30 POD for neck extension, ipsilateral lateroflexion, contralateral lateroflexion and contralateral rotation (P<0.05). No significant differences were found regarding shoulder ROM. Trapezius muscle strength, was also higher at the 30 POD in RG group (P<0.05). QOL was most impacted in the CG in the Chewing and Shoulder domains and Physical Function dimension at the 30 POD (P<0.05).
Postoperative functional morbidity was lower in patients undergoing retroauricular neck dissection. The cervical spine ROM and trapezius muscle strength were better in patients undergoing retroauricular approach and postoperative QOL was worse in patients undergoing conventional neck dissection.
经耳后入路进行的颈部清扫术作为传统入路的替代方法出现，旨在在保持治疗效果的同时降低术后发病率。这些手术方式在功能方面和生活质量（QOL）上的差异仍不明确。本研究旨在评估经传统或耳后（内镜或机器人）入路进行单侧颈部清扫术患者的解剖学和功能方面以及生活质量。
本研究连续纳入35例因头颈癌接受单侧颈部清扫术的患者，25例行传统手术[传统组（CG）]，10例行耳后入路手术[耳后组（RG）]。术前及术后第30天（POD）对患者的颈椎和肩部活动范围（ROM）、斜方肌力量和生活质量进行评估。
CG组和RG组在人体测量学、临床和手术变量方面相似。两组的平均年龄均在52至55岁之间。CG组女性占多数（52%），RG组男性占多数（70%）；P = 0.08。两组中受影响最严重的部位均为口咽，其次是甲状腺，两组最常清扫的区域均为I - III区。住院时间存在差异{CG组：5 [1 - 22]天，RG组：2 [1 - 6]天；P = 0.02}，CG组术后第30天的疼痛评分更高（P = 0.002）。关于颈椎ROM，RG组在术后第30天的颈部伸展、同侧侧屈、对侧侧屈和对侧旋转方面表现更好（P < 0.05）。在肩部ROM方面未发现显著差异。RG组术后第30天的斜方肌力量也更高（P < 0.05）。术后第30天，CG组在咀嚼和肩部领域以及身体功能维度的生活质量受影响最大（P < 0.05）。
接受耳后颈部清扫术的患者术后功能发病率较低。接受耳后入路手术的患者颈椎ROM和斜方肌力量更好，而接受传统颈部清扫术的患者术后生活质量更差。
