Department of Ophthalmology and Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Université Laval, Quebec City, QC, Canada.
Department of Surgery, Service of Otorhinolaryngology-Head and Neck Surgery, Centre Hospitalier Universitaire de Québec, Université Laval, Quebec City, QC, Canada.
J Otolaryngol Head Neck Surg. 2024 Jan-Dec;53:19160216241248666. doi: 10.1177/19160216241248666.
BACKGROUND: Different factors can affect the quality of life of patients treated for head and neck cancer undergoing major surgical intervention. However, it remains unclear which specific factors and what possible interventions could have the greatest influence on quality of life postoperatively for patients undergoing surgical resection with free flap reconstruction. The objective of our systematic review was to identify which factors, at the time of surgical treatment, are associated with a worse postoperative quality of life for patients undergoing surgical resection with free flap reconstruction for head and neck cancer. METHODS: We performed a systematic review of MEDLINE, Embase, CINAHL, Web of Science, and the Cochrane Central Register of Controlled Trials (CENTRAL), from their inception through November 2021. We included peer reviewed studies that evaluated the impact of specific factors on quality of life for adult patients who underwent surgery with free flap reconstruction for head and neck cancer. Two reviewers independently screened citations for eligibility and extracted data. Risk of bias of each study was evaluated using the New-Castle Ottawa Scale. Vote counting and qualitative review were used to synthesize results. All relevant findings were reported. RESULTS: We initially identified 1971 articles. We included 22 articles in our systematic review, totaling 1398 patients. There was a high level of variability for factors evaluated throughout studies and many studies presented small sample sizes. However, some factors were associated with worse long-term quality of life, including older age, radiotherapy, higher tumor stage, dysphagia, anxiety as well as depressive symptoms. Very few articles analyzed their data for specific tumor subsites and the impact of psychosocial factors was rarely evaluated throughout studies. CONCLUSIONS: For patients with head and neck cancer requiring free flap reconstruction, some specific factors may correlate with changes in quality of life. However, these findings are based on very few and mostly underpowered studies. A better understanding of factors affecting quality of life could allow a more personalized and overall better quality of care for patients.
背景：不同因素会影响接受头颈部癌症重大手术干预的患者的生活质量。然而，对于接受游离皮瓣重建的手术切除患者，哪些具体因素以及何种可能的干预措施对术后生活质量的影响最大，目前尚不清楚。我们的系统评价的目的是确定在手术治疗时，哪些因素与接受游离皮瓣重建的头颈部癌症手术切除患者的术后生活质量较差相关。
方法：我们对 MEDLINE、Embase、CINAHL、Web of Science 和 Cochrane 中央对照试验注册库（CENTRAL）进行了系统评价，检索时间从建库开始至 2021 年 11 月。我们纳入了评估特定因素对接受游离皮瓣重建的头颈部癌症成年患者生活质量影响的同行评审研究。两名评审员独立筛选引文以确定其是否符合纳入标准，并提取数据。使用纽卡斯尔-渥太华量表评估每项研究的偏倚风险。使用投票计数和定性综述来综合结果。报告了所有相关发现。
结果：我们最初确定了 1971 篇文章。我们的系统评价共纳入 22 篇文章，总计 1398 例患者。在整个研究中，评估的因素存在高度的变异性，并且许多研究的样本量较小。然而，一些因素与较差的长期生活质量相关，包括年龄较大、放疗、较高的肿瘤分期、吞咽困难、焦虑以及抑郁症状。很少有文章分析特定肿瘤亚部位的数据，并且整个研究中很少评估心理社会因素的影响。
结论：对于需要游离皮瓣重建的头颈部癌症患者，一些特定因素可能与生活质量的变化相关。然而，这些发现基于为数不多且大多效力不足的研究。更好地了解影响生活质量的因素可以为患者提供更个性化和整体更好的护理质量。
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