Quality of Life and Aesthetic Satisfaction in Patients Who Underwent the “Commando Operation” with Pectoralis Major Myocutaneus Flap Reconstruction—A Case Series Study

Abstract

The “commando operation” is an extensive surgical procedure used to treat patients with oral squamous carcinoma and metastasis in the cervical lymph nodes. While the procedure can be curative, it is also very mutilating, which consequently has a major impact on the patient’s quality of life. Several studies showed that the procedure is associated with loss of certain functions, such as impairments in speech, chewing, swallowing, and loss of taste and appetite. Furthermore, some of these impairments and their degree depend on the reconstruction method. However, the data regarding the functional impairments and aesthetic results in patients who underwent the “commando operation” along with the pectoralis major myocutaneus flap reconstruction are still inconclusive. This study included 34 patients that underwent partial glossectomy, ipsilateral modified radical neck dissection, pectoralis major myocutaneus flap reconstruction, and adjuvant radiotherapy. A structured questionnaire was used to evaluate aesthetical results and functional impairments as well as to grade the level of satisfaction with the functional and aesthetic outcomes both by the patients and by the operator. Most of the patients stated that their speech (N = 33; 97%) and salivation (N = 32; 94.2%) severely changed after the operation and that they cannot chew (N = 33; 97%) and swallow (N = 33; 97%) the same as before the operation. Moreover, almost half of the patients (N = 16; 47%) reported that they have severe sleep impairments. However, only few of the included patients stated that they sought professional help regarding the speech (N = 4; 11.7%), eating (N = 5; 14.7%), and sleeping (N = 4; 11.7%) disturbances. Additionally, there was a statistically significant difference between the operator and the patients in the subjective assessment of the aesthetic results (p = 0.047), as operators gave significantly better grades. Our results imply that this procedure and reconstructive method possibly cause impairments that have an impact on the patients’ wellbeing. Moreover, our outcomes also suggest that patients should be educated and rehabilitated after the “commando operation” since most of them were reluctant to seek professional help regarding their impairments. Lastly, sleep deficiency, which was observed after the procedure, should be further explored.

Decisional Conflict and Decision Regret in Head and Neck Oncology

“…Of the 28 included studies, 5 had a qualitative design (3 for DC, 1 for DR, and 1 for DC and DR) and 23 were quantitative (3 for DC, 19 for DR, and 1 for DC and DR). Publication dates ranged from 1980 to 2022, and 12 studies were less than 5 years old.…”

“…One study by Shaverdian et al considered DR of a deescalation treatment instead of regular treatment, and we excluded this study from the meta-analysis on grounds of clinical heterogeneity. Hence, meta-analyses were performed on 16 articles, using 3 different instruments (eAppendix 2 in Supplement 1): study-specific questionnaires, the Shame and Stigma Scale (SSS), and the Decision Regret Scale (DRS).…”

“…Three different instruments were used in the 20 studies assessing DR (Table 4; eAppendix 2 in Supplement 1): study-specific questionnaires (5 studies), the SSS (4 studies), and the DRS (11 studies).…”

“…All 5 articles that used a study-specific questionnaire reported prevalence as primary outcome. Four were relatively old studies (1987-2009), 1 was from 2022, and samples ranged from 76 to 273 participants. One of these studies investigated DR after surgical treatment for laryngeal cancer, and 1 after commando operation .…”

“…Another article did not have dedicated results and discussion sections and was therefore rated as high ROB (Table 1). …”