Shoulder function after neck dissection: Assessment via a shoulder-specific quality-of-life questionnaire and active shoulder abduction |
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| Authors: | Takayuki Imai Yuki Sato Jun Abe Jun Kumagai Sinkichi Morita Satoshi Saijo Tomoko Yamazaki Yukinori Asada Kazuto Matsuura |
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| Affiliation: | 1. Department of Head and Neck Surgery, Miyagi Cancer Center, 47-1 Nodayama, Medeshima-Shiode, Natori 981-1293, Miyagi, Japan;2. Department of Rehabilitation, Miyagi Cancer Center, Natori, Miyagi, Japan;3. Department of Orthopaedic Surgery, Akaishi Hospital, Shiogama, Miyagi, Japan;4. Department of Physical Therapy, Yamagata Prefectural University of Health Sciences, Yamagata, Yamagata, Japan;5. Department of Head and Neck Medical Oncology, Miyagi Cancer Center, Natori, Miyagi, Japan;6. Department of Head and Neck Surgery, National Cancer Center East, Kashiwa, Chiba, Japan;1. Department of Otolaryngology-Head and Neck Surgery, Kurume University School of Medicine, 67 Asahi-machi, Kurume 830-0011, Japan;2. Department of Otolaryngology-Head and Neck Surgery, Sato Clinic & Hospital, Oita, Japan;1. Speech Science, School of Psychology, The University of Auckland, New Zealand;2. Starship Children''s Hospital, Auckland, New Zealand;3. Section of Audiology, The University of Auckland, New Zealand;4. Eisdell Moore Centre for Research in Hearing and Balance, New Zealand;1. Department of Otolaryngology, Head and Neck Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan;2. Department of Hematology, Clinical Immunology and Infectious Disease, Ehime University Graduate School of Medicine, Toon, Japan;1. Jichi Ika University Saitama Medical Center, Department of Otolaryngology, 1-847 Amanuma, Saitama 330-8503, Japan;2. Tokyo-Kita Medical Center, Department of Otolaryngology, Tokyo, Japan;1. Departments of Otolaryngology, Japanese Red Cross Society Himeji Hospital, 12-1 Shimoteno 1-Chome, Himeji City, Hyogo 670-8540, Japan;2. Department of Otolaryngology Head and Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama City, Okayama 700-8558, Japan;3. Departments of Pathology, Japanese Red Cross Society Himeji Hospital, 12-1 Shimoteno 1-Chome, Himeji City, Hyogo 670-8540, Japan;4. Departments of Inspection technology, Japanese Red Cross Society Himeji Hospital, 12-1 Shimoteno 1-Chome, Himeji City, Hyogo 670-8540, Japan |
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| Abstract: | ObjectiveNeck dissection results in a high probability of postoperative shoulder functional impairment, even when the spinal accessory nerve is preserved. Therefore, surgeons must inform patients about the expected functional and qualitative recovery of shoulder function after surgery.MethodsThe present study included a prospective cohort of 66 patients (85 neck dissection sides) who underwent neck dissection between December 2015 and July 2017 at a single institution. The active shoulder abduction angles of the affected side and the patient-reported shoulder-specific quality-of-life recovery score of the Western Ontario Rotator Cuff (WORC) questionnaire were examined at 1, 3, 6, 9, and 12 months postoperatively. Additionally, the association between these outcomes and risk factors for shoulder impairment were investigated.ResultsThe average active shoulder abduction angles were significantly improved at 3 and 6 months postoperatively compared with 1 month postoperatively (96.5 ± 4.3° at 1 month versus 110.1 ± 4.7° at 3 months, p = 0.035, and versus 142.0 ± 4.6° at 6 months, p < 0.0001). The proportion of patients who were unable to abduct their shoulders by 150° or more was significantly lower at 6 months postoperatively (41.5%) compared with 1 month postoperatively (82.4%, p < 0.0001). The WORC score significantly improved from 60.4 ± 2.4% at 1 month postoperatively to 67.9 ± 2.6% at 6 months postoperatively (p = 0.036). Multivariate analysis revealed that postoperative radiotherapy was a significant risk factor for shoulder impairment at 3 and 6 months postoperatively (p = 0.003 and p = 0.027, respectively), and that level V dissection and head and neck irradiation were significant risk factors for a worse shoulder outcome at 6 and 9 months postoperatively (respective p values for level V dissection and head and neck irradiation were p = 0.049 and p = 0.030 at 6 months postoperatively, and p = 0.016 and p = 0.013 at 9 months postoperatively).ConclusionSatisfactory functional and qualitative recovery of shoulder function was achieved at 6 months after neck dissection. Postoperative radiotherapy was a predictor of poor shoulder function in the early postoperative period; both level V dissection and head and neck irradiation were predictors of poor shoulder function at 6 and 9 months after neck dissection. |
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