头颈癌游离皮瓣重建术后的衰弱与恢复：一项系统综述

文献信息

中文摘要

目的： 综述衰弱对接受微血管游离皮瓣重建术（MFFR）的老年头颈癌（HNC）患者各种结局的影响。
数据来源： MEDLINE、Embase和World of Science。
综述方法： 遵循PRISMA指南，两名独立评审员对MEDLINE、Embase和World of Science数据库从建库至2025年1月10日的文献进行了系统综述。纳入经同行评议的原始文献，排除病例报告，这些文献使用经过验证的衰弱指数评估了接受MFFR的HNC患者的结局。使用纽卡斯尔-渥太华量表（NOS）评估研究质量和偏倚风险。综合了关于手术和内科并发症、住院过程和功能结局的数据。
结果： 共纳入11项研究进行综述，其中6项来自美国。根据NOS，8项研究质量为“良好”。使用的衰弱测量工具包括5因素改良衰弱指数（5-mFI）、11-mFI、老年8项（Geriatric 8）、风险分类系统、预后营养指数、风险评估指数和颈椎旁骨骼肌指数。衰弱始终与内科并发症增加、住院时间延长和出院后非回家可能性更高相关。衰弱预测吞咽恢复受损和需要肠内营养的时间更长，但衰弱与手术并发症或短期死亡率之间的关联不一致。结合营养或肌少症指标的测量工具在预测术后并发症方面优于单独的衰弱指数。
结论： 在接受MFFR的患者中，衰弱始终与内科并发症、住院时间延长和功能结局较差相关。衰弱评估工具可能在术前患者咨询和预测出院需求方面具有重要作用。

英文摘要

OBJECTIVE: To review the impact of frailty on various outcomes in geriatric head and neck cancer (HNC) patients undergoing microvascular free flap reconstruction (MFFR).
DATA SOURCES: MEDLINE, Embase, and World of Science.
REVIEW METHODS: Following PRISMA guidelines, two independent reviewers performed a systematic review of MEDLINE, Embase, and World of Science databases from inception to January 10, 2025. Peer-reviewed primary literature, excluding case reports, that assessed outcomes in patients with HNC undergoing MFFR with a validated frailty index were included for analysis. Study quality and risk of bias were assessed using the Newcastle-Ottawa Scale (NOS). Data regarding surgical and medical complications, hospital course, and functional outcomes were synthesized.
RESULTS: Eleven studies were included for review, six of which were from the United States. Eight were of "Good" quality per the NOS. Utilized frailty measures included the 5-factor Modified Frailty Index (5-mFI), 11-mFI, Geriatric 8, Risk Classification System, Prognostic Nutritional Index, Risk Assessment Index, and Cervical Paraspinal Skeletal Muscle Index. Frailty was consistently associated with increased medical complications, longer hospital length of stay, and higher likelihood of non-home discharge. Frailty predicted impaired swallowing recovery and a longer need for enteral nutrition but associations between frailty and surgical complications or short-term mortality were inconsistent. Studies incorporating nutritional or sarcopenia-based measures outperformed frailty indices alone in predicting postoperative complications.
CONCLUSION: In patients undergoing MFFR, frailty was consistently associated with medical morbidity, prolonged hospitalization, and worse functional outcomes. Frailty assessment tools may have an important role in preoperative patient counseling and anticipating discharge needs.