背景:不同因素会影响接受大型手术干预的头颈部癌症患者的生活质量。然而,目前尚不清楚哪些具体因素以及哪些可能的干预措施对接受游离皮瓣重建手术切除的患者术后生活质量影响最大.我们系统审查的目的是确定哪些因素,在手术治疗的时候,对于接受手术切除并进行游离皮瓣重建的头颈部癌患者,其术后生活质量较差。
方法:我们对MEDLINE进行了系统评价,Embase,CINAHL,WebofScience,和Cochrane中央控制试验登记册(CENTRAL),从成立到2021年11月。我们纳入了同行评审的研究,这些研究评估了特定因素对接受头颈部癌游离皮瓣重建手术的成年患者生活质量的影响。两名审稿人独立筛选引用的资格和提取的数据。使用New-Castle渥太华量表评估各项研究的偏倚风险。投票计数和定性审查用于综合结果。报告了所有相关发现。
结果:我们最初确定了1971篇文章。我们在系统综述中纳入了22篇文章,共1398名患者。在整个研究中评估的因素的变异性很高,许多研究的样本量很小。然而,一些因素与长期生活质量较差有关,包括年龄较大,放射治疗,肿瘤分期较高,吞咽困难,焦虑和抑郁症状。很少有文章针对特定的肿瘤亚位点分析他们的数据,并且在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肿瘤患者,一些特定因素可能与生活质量的变化相关。然而,这些发现是基于很少的研究,而且大多是动力不足的研究。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。
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.