Patient-Reported Outcomes of Split-Thickness Skin Grafts for Floor of Mouth Cancer Reconstruction

Abstract

<b><i>Introduction:</i></b> Patient-reported outcome measures (PROM) on quality of life (QOL) for early-stage floor of mouth carcinoma (FOM-CA) undergoing surgical resection and split-thickness skin graft (STSG) reconstruction have not been established. We have performed a cross-sectional QOL analysis of such patients to define functional postoperative outcomes. <b><i>Methods:</i></b> Patients with pathologic stage T1/T2 FOM-CA who underwent resection and STSG reconstruction at a tertiary academic cancer center reported outcomes with the University of Washington QOL (v4) questionnaire after at least 6 months since surgery. <b><i>Results:</i></b> Twenty-four out of 49 eligible patients completed questionnaires with a mean follow-up of 41 months (range: 6–88). Subsites of tumor involvement/resection included the following: (1) lateral FOM (L-FOM) (<i>n</i> = 17), (2) anterior FOM (A-FOM) (<i>n</i> = 4), and (3) alveolar ridge with FOM, all of whom underwent lateral marginal mandibulectomy (MM-FOM) (<i>n</i> = 3). All patients reported swallowing scores of 70 (“I cannot swallow certain solid foods”) or better. Ninety-six percent (23/24) reported speech of 70 (“difficulty saying some words, but I can be understood over the phone”) or better. A-FOM patients reported worse chewing than L-FOM patients (mean: 50.0 vs. 85.3; <i>p</i> = 0.01). All 4 A-FOM patients reported a low chewing score of 50 (“I can eat soft solids but cannot chew some foods”). Otherwise, there were no significant differences between subsite groups in swallowing, speech, or taste. <b><i>Conclusion:</i></b> STSG reconstructions for pathologic T1–T2 FOM-CA appear to result in acceptable PROM QOL outcomes with the exception of A-FOM tumors having worse chewing outcomes.

Mastication in health‐related quality of life in patients treated for oral cancer: A systematic review

“…The included studies involved a total of 1849 oral cancer patients of which at least 1308 were male, as one study did not report sex of patients (Vakil et al, 2012 ). Eleven studies only reported mean or median age with SD and did not mention range (Agarwal et al, 2014 ; Bekiroglu et al, 2011 ; Gu et al, 2021 ; Hoene et al, 2021 ; Larson et al, 2021 ; Rogers et al, 2004 ; Rogers & Lowe, 2020 ; Seferin et al, 2022 ; Soares et al, 2018 ; Wu et al, 2020 ; Zhang et al, 2020 ). One study did not mention age of patients (Vakil et al, 2012 ) and three studies categorised patients in age groups without further details about mean and SD (Rogers & Lowe, 2020 ; Yue et al, 2018 ; Zhang et al, 2020 ).…”

“…One study did not mention age of patients (Vakil et al, 2012 ) and three studies categorised patients in age groups without further details about mean and SD (Rogers & Lowe, 2020 ; Yue et al, 2018 ; Zhang et al, 2020 ). Studies were mainly conducted in China (Fang et al, 2014 ; Fang et al, 2013 ; Gu et al, 2021 ; Li et al, 2013 ; X. Li, Sun, & Guo, 2016 ; W. Li, Zhang et al, 2016 ; Wu et al, 2020 ; Yan et al, 2017 ; Yang et al, 2014 ; Yuan et al, 2016 ; Yue et al, 2018 ; Zhang et al, 2020 ; Zhang et al, 2013 ), followed by India (Agarwal et al, 2014 ; Ghai et al, 2021 ; Sakthivel et al, 2017 ; Vora et al, 2017 ), the United Kingdom (Bekiroglu et al, 2011 ; Devine et al, 2001 ; Rogers et al, 2004 ; Rogers & Lowe, 2020 ), Brazil (Seferin et al, 2022 ; Soares et al, 2018 ), the United States (Larson et al, 2021 ; Ochoa et al, 2021 ), Germany (Hoene et al, 2021 ) and Pakistan (Vakil et al, 2012 ).…”

“…In some studies, patients administered the questionnaire at least once pre‐ and post‐treatment (Agarwal et al, 2014 ; Yan et al, 2017 ). Patients in other studies administered the questionnaire only once post‐treatment (Bekiroglu et al, 2011 ; Devine et al, 2001 ; Fang et al, 2013 ; Fang et al, 2014 ; Ghai et al, 2021 ; Gu et al, 2021 ; Larson et al, 2021 ; Li et al, 2013 ; Li et al, 2016 ; Ochoa et al, 2021 ; Sakthivel et al, 2017 ; Seferin et al, 2022 ; Soares et al, 2018 ; Vakil et al, 2012 ; Vora et al, 2017 ; Wu et al, 2020 ; Yang et al, 2014 ; Yue et al, 2018 ; Zhang et al, 2013 ; Zhang et al, 2020 ). The questionnaire was administered twice post‐treatment in two studies (Rogers & Lowe, 2020 ; Yuan et al, 2016 ).…”

“…Subgroups of studies: 2 = Bekiroglu et al ( 2011 ) ( I : no RT, II : RT); 3 = Devine et al ( 2001 ) ( I : LSM, II : V/MLR); 5 = Fang et al ( 2014 ) ( I : FF rec., II : no FF rec. ); 6 = Ghai et al ( 2021 ) ( I : T1 without RT, II : T2 without RT, III : T1 and T2 with RT); 7 = Gu et al ( 2021 ) ( I : ND with submandibular gland preservation, II : conventional ND); 9 = Larson et al ( 2021 ) ( I : lateral FOM, II : anterior FOM, III : alveolar ridge with FOM); 11 = Li et al ( 2016 ) ( I : PMMF, II : RFFF); 12 = Li et al ( 2016 ) ( I : RT pre‐Tx, II : RT post‐Tx, III : RT pre‐ and post‐Tx, IV : no RT); 14 = Rogers et al ( 2004 ) ( I : nil, II : rim res., III : segment res. ); 16 = Sakthivel et al ( 2017 ) ( I : surgery, II : adjuvant therapy); 17 = Seferin et al ( 2022 ) ( I : sentinel lymph node biopsy, II : cervical ND levels I–III); 21 = Wu et al ( 2020 ) ( I : classic ALTFF, II : chimeric ALTFF); 22 = Yan et al ( 2017 ) ( I : long‐term survivors, II : non‐survivors); 24 = Yuan et al ( 2016 ) ( I : RFFF, II : ALTFF); 25 = Yue et al ( 2018 ) ( I : tongue, II : other, III : no rec., IV : rec.…”

“…Another focus of attention is the survey follow‐up time. Twenty of the 27 studies had patients complete the questionnaire only once, making it impossible to evaluate changes in chewing capacity (Devine et al, 2001 ; Fang et al, 2014 ; Fang et al, 2013 ; Ghai et al, 2021 ; Gu et al, 2021 ; Larson et al, 2021 ; Li et al, 2013 ; Li et al, 2016 ; Li et al, 2016 ; Ochoa et al, 2021 ; Sakthivel et al, 2017 ; Seferin et al, 2022 ; Soares et al, 2018 ; Vakil et al, 2012 ; Vora et al, 2017 ; Wu et al, 2020 ; Yang et al, 2014 ; Yue et al, 2018 ; Zhang et al, 2018 ; Zhang et al, 2020 ). Three of these studies had an assessment range of 1 year or less (Gu et al, 2021 ; Vakil et al, 2012 ; Wu et al, 2020 ).…”