Quality of Life Outcomes in Patients after Partial Glossectomy for T1-T3 Squamous Cell Carcinoma and Reconstruction with Either Primary Closure or Radial Free Forearm Flap

The Quality of Life (QOL) of patients who undergo glossectomy is an important factor to consider when contemplating reconstruction. There is a lack of consensus among clinicians as to the best method of reconstruction for a medium sized defect (T1-T3 tumours). In this study we assess and compare the QOL outcomes of patients with T1-T3 SCC of the tongue treated with partial glossectomy followed by either primary closure (PC) or free flap reconstruction. We further analyze QOL outcomes based on tumour size (TS) and volume of resection (VOR).

All patients diagnosed with squamous cell carcinoma (SCC) of the tongue and treated at the McGill University Health Centre Department of Oral & Maxillofacial Surgery between December 2008 and December 2015 were included. Patients who were deceased, had a recurrence or another head and neck primary were excluded. A retrospective analysis of all patient medical records was conducted and the following information was collected: patients' age, gender, smoking, alcohol consumption, tumour location, extent of resection, neck and reconstructive interventions as well as adjunct therapeutic measures, and time since surgery were recorded. TS, depth of invasion, tumour stage and VOR (based on the gross pathologist measurements) were assessed from final pathology reports. Patients were contacted by mail at least one year after surgery and asked to complete the University of Washington (v.4) QOL assessment. A descriptive analysis was used to interrupt the data.

Twenty eight patients (12 female and 16 male) were included. The patients’ age ranged from 29 to 89 years, with a mean age of 64. Tongue tumours consisted of twenty T1 lesions, seven T2 and one T3. All patients underwent partial glossectomy within the hemitongue. Twenty two patients underwent selective neck dissection, twenty three patients had PC of the surgical defect, while four had reconstruction with radial free forearm flap (RFFF). All patients who underwent reconstruction received neck dissections and adjuvant radiotherapy while ten of the twenty three patients who underwent PC received adjuvant radiotherapy. The TS ranged from 0.3 to 4.8cm, with a mean of 2.0cm. The VOR ranged from 3.9 to 95.5cm³ with a mean of 26.5cm³.

Twenty one patients returned completed QOL questionaries. Overall QOL of our group was 74.5%, with a mean of 81.5% for the PC group and 70% for the RFFF group. Overall the QOL of both groups improved comparatively to one month prior to surgery. When correlating TS to composite score (CS) for all domains assessed, TS greater than 2cm and VOR greater than 20cm³ were related with a decrease in CS and QOL. In our limited study, patients with a VOR > 20cm³ had no significant improvement in QOL whether treated with RFFF or PC. Swallowing, speech, taste, saliva and mood were rated the most important parameters on the QOL assessment. The PC group showed better CS for swallowing, speech, saliva and mood. Regardless of the reconstruction rendered, patients who underwent postoperative radiotherapy showed poor overall QOL outcomes and the lowest composite scores for the above mentioned domains regardless of the type of reconstruction.

Overall the QOL improved in both groups postoperatively. Patients who underwent PC had higher CS and overall QOL. Although limited in number, our RFFF group did not seem to have an appreciable improvement in the QOL when compared to patients that underwent PC for medium sized defects of the tongue.

1. Hsiao H-T, Leu Y-S, Lin C-C.: Primary closure versus radial forearm flap reconstruction after hemiglossectomy: functional assessment of swallowing and speech. Ann Plast Surg49:612–616, 2002.

2. Chuanjun C.: Speech after partial glossectomy: A comparison between reconstruction and nonreconstruction patients. Journal of Oral and Maxillofacial Surgery60:404–407, 2002.