Persistent Postsurgical Pain in Oral Cancer Patients Reconstructed with Anterolateral Thigh Free Flap

Abstract

Background and Objectives: The anterolateral thigh (ALT) flap is widely used in head and neck reconstruction, but the postoperative thigh sensory function lacks sufficient evaluation. The present study reports the postsurgical pain and cancer-related quality of life (QoL) in different stages of oral cancer patients receiving anterolateral thigh (ALT) flap reconstruction. Materials and Methods: Patients were subgrouped into postoperative early-, mid-, and late-recovery stages (postoperative 0.5–1 years, 1–2 years, and above 2 years) according to the time point of assessment. The QoL was examined using the EORTC C-30. Postsurgical donor and receipt site pain was evaluated through subjective reports and sensory tests. Results: Ninety-four patients were included in the final analysis. The functional and global health-related QoL significantly improved with time after surgery. However, spontaneous pain was reported in 57.7%, 72.3%, and 42% of patients in early-, mid-, and late-recovery stages, mainly in donor sites rather than in receipt sites. The highest incidence of donor site pain after ALT flap reconstruction in oral cancer surgery was in the mid-recovery stage but remained high in the late-recovery stage (56.8% and 36.7%, respectively). Conclusions: The postsurgical pain in the donor site might persist to or exhibit delayed onset one to two years postoperatively but is much improved after postoperatively two years later. A longer postsurgical follow-up for over two years for pain and sensory dysfunction is indicated.

Long‐term patient‐reported outcomes after reconstructive surgery for head and neck cancer: A systematic review

“…From the remaining 2507 articles, 2273 were excluded after review of title and abstract. The remaining 234 studies were assessed in full‐text form, of which 30 articles were eligible for our systematic review 13–42 . A detailed overview of the study selection process is shown in Figure 1.…”

“…Most patients scored good on the pain domains of the HRQoL‐questionnaires, especially on the long term, indicating little pain. HRQoL after 1 year was a good predictor for long‐term HRQoL, often with few to no significant changes in the years following treatment (Data S1, Appendix 3, table 5) 18,23,28,31,37,39,40 . Scores for the pain domain in the UW‐QoL ranged approximately from 75 to 90, while for the EORTC QLQ‐C30 scores ranged from 20 to 25, and for the EORTC QLQ‐H&N35 from 20 to 25.…”