Surgical complications and quality of life according to the extent of neck dissection in patients treated for oral squamous cell carcinoma.

Objective: Quality of life (QoL) and the degree of postoperative morbidity is an important aspect for patients suffering from oral squamous cell carcinoma (OSCC), which can be affected by several aspects of cancer treatment and especially the extent of surgical therapy. The aim of this study was to evaluate the clinical outcome and QoL in patients in relation to different types of neck dissection (ND) for OSCC.

Materials and methods: In this observational single center cohort study, OSCC patients who underwent primary resection and ND between 2017 and 2022 were included and assessed for postoperative complications. Furthermore, a subcohort of patients who presented in regular tumor aftercare was prospectively examined regarding QoL and shoulder functioning, using a modified version of the EORTC quality of life core questionnaire with its head and neck cancer module (EORTC-QLQ-H&N43). Differences in QoL between patients were analyzed regarding the extent of ND (selective vs. modified radical ND; ipsilateral vs. bilateral ND), adjuvant therapy and presence of postoperative complications.

Results: Overall, 350 patients with a mean age of 66 years (± 11.6) were enrolled in the study. The overall complication rate was 12.6%, while extended ND procedures (modified radical ND and bilateral ND) were associated with higher complications. A subcohort of 57 patients participated in QoL assessment. There were clinically relevant differences (20 points and more in QoL) in relation to the extent of ND in the following domains: impaired swallowing of solid food, mouth opening limitation, sticky saliva, impaired smelling, impaired eating ability, impaired speech, shoulder pain and stiffness in the neck and shoulder area, while selected objects were influenced by adjuvant therapy. While patients with extended neck treatment presented with significantly more shoulder pain, there were no significant differences in shoulder functioning among the different ND modalities.

Conclusions: The results of this study provide an insight into QoL issues in relation to OSCC and may help to consult patients who are confronted at the beginning of the disease as well as by approaching selected health issues by specific functional treatment during follow-up.

Clinical relevance: In this study, it could be shown that extensive surgical neck treatment is associated with higher complication rates and lower quality of life, highlighting the relevance of surgical de-escalation if feasible.