Of 656 patients identified, 78 patients with a MSMM approach and 415 with a LSM approach were included. Seventy-one MSMM and 372 LSM patients were considered because other patients met exclusion criteria. The 55 most recent patients in each group were contacted for enrollment. Forty-three in each arm agreed to participate and became paired cohorts, whose characteristics were listed in Table 1. There was no statistically significant difference in age, gender and tumor stage between MSMM and LSM group.
Both MSMM and LSM approach showed good tumor exposures and all tumors were resected in an en bloc fashion with negative resection margins. The neck dissection of patients was similar in both groups and they were received functional neck dissection, radical neck dissection or bilateral neck dissection based on clinical imaging evaluation of cervical lymph node(P＞0.05). The defects were reconstructed with an anterolateral thigh free flap, a radial forearm free flap, or a posterior tibial artery free flap. There was no difference in application of free flaps between MSMM group and LSM group(P＞0.05). The number of patients received postoperative tracheostomy was similar in MSMM group and LSM group (88.4% VS. 90.7%, P＞0.05). The operation time was shorter in MSMM group than that in LSM group (295 ± 93 VS. 323 ± 78, minutes, P=0.037). The cases of patients stayed in ICU (intensive care unit) postoperatively were similar in both groups (16.3%% VS. 16.3%%, P＞0.05). The number of patients received tube feeding was similar in MSMM group and LSM group (67.4% VS. 72.1%, P＞0.05), but the patients in MSMM group return to oral feeds were earlier than LSM group (5.5± 2.1 VS. 7.1± 3.3, P=0.023). These data indicated that the function of lip was recovered faster in MSMM group. The two groups have similar durations of postoperative hospital stay (8.2± 2.5 VS. 8.9± 2.9, P＞0.05). The perioperative characteristics were demonstrated in Table 1.
The median follow-up time was 39 months and 40 months in MSMM group and LSM group respectively. There was no significant difference in postoperative complications, including wound dehiscence, fistulae between the MSMM group and LSM group. The patients received postoperative radiotherapy or radiochemotherapy were comparable in both groups (41.9% VS. 39.5%, P＞0.05). In follow-up period, there was 1 and 2 patients were found osteoradionecrosis in MSMM group and LSM group respectively. There was no difference of recurrence, distant metastasis and patient survival status in both groups (P＞0.05). DFS of patients was 36/43 (83.7%) and 37/43 (86%) in MSMM group and LSM group respectively. Patients were AWD and DOD were 5 (11.6%) and 2 (4.7%), 3 (7%) and 3 (7%) in MSMM group and LSM group respectively. Those data was demonstrated in Table 2.
Scar assessment was performed at 1, 6, 12 and 24 months after surgery for patients of DFS. The scale scores of scar assessment and disfigurement were shown in Table 3. The scores of both OSAS and PSAS were significant higher in LSM group than MSMM group. The scores about overall disfigurement based on 10-point Likert scale from both patients and clinician observers were higher in LSM group than MSMM group (Table 3, P<0.05). These data indicated that the subjective and objective scar was better in MSMM group and they have better facial appearance after surgery (Table 3 and Fig2, P<0.05). The lip functional assessments were shown in Table 3. There was no difference of lip function between patients in LSM group than MSMM group.
All patients of DFS in this study were completed the UW-QOL version 4 questionnaires at 1, 6, 12 and 24 months after surgery. The scores of questionnaires were shown in Table 4. There were no differences in the baseline scores of all domains between MSMM group and LSM group. The patients in both groups scored similarly for pain, activity, speech, swallowing, chewing, taste, shoulder and salvia at every time point in follow-up period. However, there was significant difference between the MSMM group and LSM group for the appearance at every time point in follow-up period. The scores of appearance from patients in MSMM group were much higher than that in LSM group. The findings for recreation, mood and anxiety were better in the MMSM group than that in the LSM group at 1 month, but there was no difference at 6, 12 and 24 months. The overall QOL of the patients in the MSMM group was better than that in the LSM group at 1 and 6 months based on the questionnaire scores.