Functional outcomes and quality of life in patients who undergone conventional or endoscopic/robotic retroauricular neck dissection: a case-control study

Erickson Borges-Santos; Telma Ribeiro Rodrigues; Renan Bezerra Lira; Marco Aurelio Vamondes Kulcsar; Luiz Paulo Kowalski

doi:10.21037/gs-23-471

Functional outcomes and quality of life in patients who undergone conventional or endoscopic/robotic retroauricular neck dissection: a case-control study

Gland Surg. 2024 Apr 29;13(4):490-499. doi: 10.21037/gs-23-471. Epub 2024 Apr 10.

Authors

Erickson Borges-Santos¹, Telma Ribeiro Rodrigues², Renan Bezerra Lira², Marco Aurelio Vamondes Kulcsar³, Luiz Paulo Kowalski^{2

3}

Affiliations

¹ Oncology Postgraduate Program, University of São Paulo Medical School, São Paulo, Brazil.
² Head and Neck Surgery and Otorhinolaryngology Department, A. C. Camargo Cancer Center, São Paulo, Brazil.
³ Head and Neck Surgery Department, University of São Paulo Medical School, São Paulo, Brazil.

Abstract

Background: Neck dissection performed via retroauricular approach emerged as an alternative to the conventional approach, aiming to maintain therapeutic efficacy with lower postoperative morbidity. Differences among these modalities in terms of functional aspects and quality of life (QOL) remains unclear. This study aims to evaluate the anatomical and functional aspects and the QOL in patients undergoing unilateral neck dissection via conventional or retroauricular (endoscopic or robotic) access.

Methods: This study involved consecutively 35 patients who underwent unilateral neck dissection for head and neck cancer, 25 submitted to the conventional surgery [conventional group (CG)] and 10 to the retroauricular approach [retroauricular group (RG)]. Patients were evaluated preoperatively and on the 30^th postoperative day (POD) regarding range of motion (ROM) of the cervical spine and shoulder, trapezius muscle strength and QOL.

Results: The CG and RG were similar in terms of anthropometric, clinical and surgical variables. The mean age of both groups was between 52 and 55 years old. There was a predominance of females in the CG (52%) and males in the RG (70%); P=0.08. The most affected site was the oropharynx followed by the thyroid in the two groups and the most frequently dissected levels were I-III in both groups. There was a difference in the length of hospital stay {CG: 5 [1-22] days and RG: 2 [1-6] days; P=0.02} and pain scores at the 30^th POD was higher in CG group (P=0.002). Regarding the cervical spine ROM, it was better in RG in the 30^th POD for neck extension, ipsilateral lateroflexion, contralateral lateroflexion and contralateral rotation (P<0.05). No significant differences were found regarding shoulder ROM. Trapezius muscle strength, was also higher at the 30^th POD in RG group (P<0.05). QOL was most impacted in the CG in the Chewing and Shoulder domains and Physical Function dimension at the 30^th POD (P<0.05).

Conclusions: Postoperative functional morbidity was lower in patients undergoing retroauricular neck dissection. The cervical spine ROM and trapezius muscle strength were better in patients undergoing retroauricular approach and postoperative QOL was worse in patients undergoing conventional neck dissection.

Keywords: Neck dissection; articular range of motion (articular ROM); head and neck neoplasm; muscle strength; robotic surgery procedures.