Impact of Patients' Preoperative Psychological Baseline on Postoperative Voice and Quality of Life Following Pharyngo-Laryngectomy with Anterolateral Thigh Flap Reconstruction: A Preliminary Study.

BACKGROUND

Patients undergoing total pharyngo-laryngectomy with anterolateral thigh (ALT) free-flap neopharyngeal reconstruction require prolonged voice rehabilitation, yet whether preoperative psychological characteristics predict postoperative voice and quality-of-life (QoL) outcomes in this surgical population has not been examined. We aimed to characterize changes in voice and QoL after this surgery and to explore associations between baseline psychological characteristics and depressive somatic symptoms and these postoperative outcomes.

METHODS

In this preliminary, single-center prospective study, 12 adult male patients undergoing primary or salvage total pharyngo-laryngectomy with simultaneous ALT free-flap neopharyngeal reconstruction were enrolled. Health-related QoL (EORTC QLQ-C30 and QLQ-H&N35), personality (Big Five Inventory, BFI), and depressive somatic symptoms (Depression and Somatic Symptoms Scale, DSSS) were assessed at baseline, 3 months, and 6 months postoperatively; the structured psychiatric interview (Mini International Neuropsychiatric Interview, MINI) was administered at baseline. Voice intelligibility (word correct rate), maximum phonation time, and speaking rate were assessed at baseline, 3 months, and 6 months postoperatively. Within-participant changes were analyzed with the Friedman test, and associations were examined using Spearman correlation.

RESULTS

Cancer diagnoses included hypopharyngeal (n = 6) and laryngeal (n = 6) cancer; 10 of 12 participants underwent salvage surgery. EORTC QLQ-H&N35 speech problem scores decreased at 6 months (p = 0.036) and dry mouth scores at 3 months (p = 0.044) relative to baseline, while QLQ-C30 cognitive functioning decreased (p = 0.048) and sense problem scores increased (p = 0.011) over follow-up. Higher baseline neuroticism (r = -0.928, p = 0.008) and DSSS total scores (r = -0.928, p = 0.008) were negatively correlated with the 3-to-6-month change in word correct rate. Higher baseline DSSS was associated with poorer 6-month cognitive (r = -0.678, p = 0.031) and social functioning (r = -0.786, p = 0.007), and with higher pain scores (r = 0.663, p = 0.037).

CONCLUSION

In this preliminary cohort, voice intelligibility and several QoL domains improved relative to baseline after pharyngo-laryngectomy with ALT free-flap neopharyngeal reconstruction, while patient-reported cognitive function and sense problems declined. Higher baseline neuroticism and depressive somatic symptoms were associated with smaller postoperative gains. Given the small sample size and the absence of a comparator group, these exploratory findings require confirmation in larger studies before preoperative psychological screening can be recommended for routine clinical use.