With the change of the concept of health, the evaluation of quality of survival has become one of the important indicators of clinical trial efficacy assessment. Modern research on quality of life emphasizes not only physical functioning, but also social functioning (social adaptation, social support, etc.) and harmony with the environment. In the past 30 years, quality of life (QOL) research has been progressing in the medical field, and QOL has been widely used in the assessment of patients with malignant tumors, providing a comprehensive basis for the screening of treatment methods or interventions and the decision of health resources allocation. I. Concept of survival quality Over the years, numerous scholars have explored the concept of survival quality and put forward hundreds of concepts of survival quality. Since scholars are mostly from their own specialties or perspectives, they may have different understandings, thus leading to the multiplicity and complexity of quality of survival, and there is no satisfactory definition so far. The concept proposed by Lennart Levi is a comprehensive measure of an individual’s or group’s perceived physical, psychological, and social well-being, and the results are expressed in terms of happiness, satisfaction, or contentment; the concept proposed by Schipper H is a practical, everyday functional description of a patient’s physical, psychological, and social responses to illness and treatment; The concept proposed by the WHO Quality of Survival Study Group is the experience of individuals in different cultures and value systems regarding their survival in relation to their goals, expectations, standards, and concerns. Survival quality is a multidimensional concept that includes physical functioning, psychological functioning, social functioning; and symptoms related to illness or treatment; survival quality is a subjective evaluation indicator that should be evaluated by the test subjects themselves. The WHO concept of quality of survival better reflects this understanding, both in terms of its subjective experience of all aspects of life and its definition in a certain cultural context and value system. The basic meanings of survival quality are: (1) survival quality is subjective and comes from the patient’s feelings; (2) survival quality is multidimensional and covers many aspects of the patient’s life; and (3) survival quality is dynamic and changes with time and environment [3]. In addition, people in different cultural systems have different subjective evaluations of survival quality, so survival quality is culturally dependent [2]. II. Measurement of survival quality The purpose of survival quality measurement is to promote patient recovery, evaluate treatment effects, and predict treatment response. In general, the combination of questionnaires and face-to-face interviews can help to obtain better results. The main components of survival quality include: (1) functional status, including daily living ability, social function, intelligence, emotional status, economic status, etc.; (2) patient’s feelings, which are subjective compared to functional status; and (3) symptoms caused by disease and treatment. The content of the measurement mainly revolves around physical, psychological and social aspects to evaluate the patient’s quality of survival and the impact of disease and treatment methods on the physical, psychological and social aspects of the patient. For example, WHO’s quality of life measurement includes: ① physical function, ② psychological condition, ③ independence, ④ social relationship, ⑤ living environment, ⑥ religious beliefs and spiritual support, etc.; each major area is divided into some small areas, a total of 24 small areas. The form used for quality of life measurement is carefully designed, selected through a series of processes such as item analysis and reflective scale positioning, and arranged in a certain format to form; its selection of each item is expressed in a certain reflective scale, and thus can be quantified according to a predetermined standard score, so it is called a scale; some people will only measure a part of the quality of life form is also called a scale. According to the different objects, the scales of quality of life measurement can be divided into the following three categories: ① generic scale: applicable to the determination of quality of life of the general population, such as SF-36, WHOQOL-100 and other scales; ② disease-specific scale: applicable to specific populations (disease patients and some ②disase-specific scale: scales applicable to specific populations (disease patients and certain special populations), including FLIC, EORTC QLQ-C30, etc. Domain-specific scale: scales that focus on a certain domain of quality of life, such as scales that focus on the evaluation of disease symptoms and treatment side effects. The scale generally contains the following basic elements and levels: ①item is the most basic component of the scale, which is the smallest component unit that cannot be divided; ②facet is also called sub-facet, which consists of several items reflecting the same characteristics; ③domain is also called aspect, which refers to a larger functional part of the quality of life and consists of several closely related small aspects; ④ The overall scale is a complete scale consisting of several domains. In recent years, with the improvement of tumor cure rate and survival rate, the evaluation of tumor treatment effect has also changed from the traditional focus on cure rate, survival rate and functional reconstruction to emphasizing the improvement of survival quality of patients after treatment on the basis of the first three [4].In 2003, Bianxue et al. searched the domestic and international literature for a total of scales used to measure the survival quality of head and neck tumor patients, including PSS-HN, UWQOL HNRQ, QOL2RTI/ H&N , QL2H &N, QLQ, HNQoL, EORTC QLQ-C30/H&N35 and FACT-H&N, and nine others. The current direction of development of survival quality scales is to develop a multidimensional comprehensive questionnaire that represents the commonality of different populations, with a short special questionnaire to assess the quality of survival of different populations; this can make the study results both relevant and comparable; for example, the University of Washington Quality of Survival Head and Neck Scale (UW-QOL), which is commonly used for head and neck tumors, consists of 9 disease-specific items and 3 comprehensive items that measure the overall relevant quality of survival. The European Organization for Research and Treatment of Cancer (EORTC) includes a 30-question core scale (EORTC QLQ-C30) and the head and neck add-on module EORTC-N&H35, which can reflect the overall quality of survival in one scale. The impact of various types of neck clearance on the quality of patient survival The Cancer Control Research Society of the Southwest Oncology Organization of the United States recommended in 1989 the use of survival quality measures for patients with the following cancers: ① cancers with poor prognosis; ② cancer treatment problems involving the comparison of different protocols; ③ the evaluation of the effectiveness of adjuvant treatment measures for recurrence in patients with breast, melanoma, and colorectal cancer; ④ the comparison of different treatment intensities and durations (5) Comparison of different treatment options with similar survival time but different quality of survival. The surgical treatment of metastatic neck cancer involves the comparison of different treatment options, which may have the same or similar oncological effects between different surgical modalities but different effects on survival quality, and thus their effects on survival quality have been paid attention to by many scholars. It has been shown that there is a close relationship between shoulder and neck pain and quality of survival in patients with head and neck cancer after neck clearance surgery. Shah et al. showed that the survival quality of patients after neck clearance improved gradually with time after surgery by using a homemade post-neck clearance quality of survival scale and the SF-12 questionnaire, etc. Shoulder discomfort and neck tightness had a greater impact on survival quality, and classical neck clearance had a greater impact on survival quality than modified neck and elective neck clearance. Taylor et al [9] observed that patient’s age, weight, radiation treatment and type of neck clearance were important factors influencing the quality of survival after neck clearance. The effect of elective neck clearance, modified neck clearance and classical neck clearance on the quality of patient survival has become the focus of research in recent years. To compare the functional changes of patients after cervical elective clearance, modified cervical clearance and classical cervical clearance, Zhang Bin et al. designed a functional questionnaire for head and neck tumor patients after cervical clearance surgery in China, which consisted of seven questions, including shoulder functional status, neck skin sensation and neck appearance, and each question had three levels. The questionnaire was used to study squamous carcinoma of the upper respiratory and digestive tracts without tumor recurrence during the follow-up period, and the cervical elective regional clearance was either suprascapulolingual muscle clearance (zones I-III) or lateral cervical clearance (zones II-IV). A total of 32 valid questionnaires were received; the results showed that the incidence of seven symptoms: shoulder pain, shoulder ptosis, decreased shoulder mobility, decreased skin sensation (at the earlobe, neck, and clavicle), neck depression deformity, neck surgical scar, and facial swelling were the lowest in cervical elective clearance, the second highest in cervical modified clearance, and the highest in cervical classical clearance, with statistically significant differences; the three major symptoms: periapical dysfunction, decreased skin sensation In the comparison of the three major groups of symptoms: periapical dysfunction, decreased skin sensation and altered neck appearance, the functional impact of elective neck clearance was the lowest. Yang Kai et al. evaluated the survival quality of 46 patients with stage III and IV oral squamous carcinoma using the University of Washington survival quality questionnaire by using modified neck debridement and classical neck debridement in 23 cases each, and there were no statistical differences in age and stage between the two groups, thus they were comparable; for oncologic outcomes, the 3-year survival rate (60.7% and 61.8%) and 5-year survival rate (48.6% and 50.9%) were not statistically significant; while the results of survival quality analysis showed that the mean total survival quality scores of patients with modified neck debridement were higher than those of patients with classic neck debridement, suggesting that the survival quality of patients with modified debridement was better than that of patients with classic neck debridement. The comparison of the two groups showed that the modified cervical dissection patients were better than the classical cervical dissection patients in four of the nine aspects of the scale, including pain, facial appearance, mobility, recreation, work, chewing, swallowing, speech, and shoulder function. Ma Jian et al. used the comprehensive quality of life assessment questionnaire prepared by the former Second Hospital of Hunan Medical University (the questionnaire includes 4 dimensions, such as physical function, psychological function, social function and material life, each dimension includes 4 factors, each factor has two types of entries, objective and subjective indicators, and each factor contains unequal entries, totaling 74 entries). The effect of whether the paraspinal nerve was preserved during cervical dissection on the quality of survival was studied in 54 patients with hypopharyngeal carcinoma, including 39 cases in the group with preserved paraspinal nerve and 15 cases in the group without preserved paraspinal nerve, and the 3-year survival rate of the two groups was not statistically significant (61.5% and 66.7%); the results of survival quality analysis showed that the somatic function dimensions (sleep and energy, somatic discomfort, food and sexual function, motor and sensory The results of the quality of survival analysis showed that the parasympathetic group was better than the non-parasympathetic group in the physical function dimension (four factors, including sleep and energy, somatic discomfort, food and sexual function, and motor and sensory function), psychological function dimension (three factors, including mental tension, positive and negative emotions, and self-esteem), social function dimension (four factors, including social support and social life, leisure and recreational life, work, marriage and family), and material life dimension (economic status factor). In addition, Ma Jian et al. used a questionnaire designed by Bin Zhang et al. to compare the postoperative function of 54 hypopharyngeal cancer patients who preserved the paraspinal nerve during cervical dissection with those who did not, and the results showed that for all of the seven symptom problems mentioned above, the patients who preserved the paraspinal nerve had better symptoms than those who did not, and the differences were all statistically significant, and the findings were consistent with those reported by Bin Zhang et al. Inoue et al [13] established a self-assessment questionnaire for quality of survival after neck clearance and an upper limb abduction test to evaluate the quality of survival after various modified neck clearance procedures. The questionnaire focused on neck and shoulder symptoms, limitations in daily activities, and occupational and leisure activities. The scores were judged according to self-rated responses, with each entry scored from 1 to 5, with 5 indicating better quality of life and 1 indicating poorer; to accurately evaluate the effect of various factors on quality of life after neck clearance, patients were asked to separate the left side of the neck from the right side of the neck when answering questions 1 to 7, and the questionnaire is shown in Table 13-2. Inoue et al [13] also established a simple upper extremity abduction test to evaluate shoulder function associated with neck clearance Inoue et al [13] evaluated upper extremity abduction test and questionnaire in 74 patients after neck clearing surgery by asking them to abduct their upper extremities palm down and assessing the abduction function with a score from 0 to 5 according to the objective evaluation of symptoms and shoulder mobility, with a high score indicating a better quality of survival, as shown in Figure 13-1. These 74 patients were 12 months-23 years after cervical clearance, with a mean of 36 months; 41 had bilateral cervical clearance and 33 had unilateral cervical clearance; the results showed that patients with preserved paraspinal nerves had better shoulder function, patients with preserved paraspinal nerves and without zone IV and V clearance scored better in assessing pain, neck tightness, and sacrifice of the sternocleidomastoid muscle and/or spinal The paraspinal nerve had significant adverse effects on daily activities, labor and leisure, and upper extremity abduction function scores were significantly correlated with responses to questions on shoulder function in the questionnaire; the results suggest that modifications to classical cervical clearance can help improve the quality of survival after surgery. In recent years, the surgical approach of preserving cervical sensory nerves during cervical clearing to reduce injury while ensuring oncologic outcomes has gradually gained attention. To investigate the effect of preserving sensory nerves on patients’ pain and quality of survival during elective neck clearance or modified neck clearance, Roh et al. retrospectively compared 24 patients who preserved cervical sensory nerve root branches during neck clearance with 29 patients who had nerve branches removed intraoperatively; both groups had intraoperative preservation of the paraspinal nerves. Neck and shoulder pain was evaluated 12-34 months (mean 18.7 months) after surgery in both groups; neck and shoulder pain was measured by visual analog scoring (VAS, a convenient method for measuring pain intensity, using a 100-mm straight line with the left end of the line indicating “no pain” and the right end indicating “unbearable pain “Patients marked the pain intensity they felt on the line, and the distance between the left end of the line and the marked point indicated the patient’s pain intensity); the sensory and motor functions of the neck were measured; the Beck questionnaire was used to assess depression; and the EORTC-N&H35 questionnaire was used to investigate the quality of survival. The incidence and severity of neck and shoulder pain were reduced in patients with preserved sensory nerves compared with those without preserved sensory nerves; compared with those with preserved sensory nerves. The incidence of abnormal pain, nociceptive hyperalgesia, earlobe and lateral cervical sensory loss, and depression was increased in patients who did not retain sensory nerves; measurement using the EORTC-H&N35 scale showed that patients who did not retain sensory nerves had higher scores than those who retained sensory nerves in four of the scale’s 14 indicators, including pain, social connectedness, sense of illness, and analgesic medication use, suggesting that patients who did not retain sensory nerves Patients had a lower quality of survival in these areas. Thus, Roh et al. concluded that preservation of the cervical sensory nerve root branches during cervical clearance helps to reduce postoperative pain and permanent neck numbness in the region, and improves the psychological status and quality of survival of postoperative patients. In some medical centers in Western countries, simultaneous radiotherapy is used for many head and neck tumors. The decision to add neck clearance after simultaneous radiotherapy for oncological reasons in patients treated with radiotherapy is a complex issue, and evaluation of quality of survival can help in this clinical decision [14]. To investigate the impact of simultaneous radiotherapy followed by neck clearance on survival quality, Donatelli-Lassig et al. conducted a prospective study of 103 patients with oropharyngeal cancer to compare the quality of survival in patients who received radiotherapy and those who received radiotherapy followed by neck clearance; all 103 patients were selected, first-treatment stage IV oropharyngeal squamous carcinoma patients, and all had a survival of more than 1 year after treatment. Of the 103 patients, 61 had radiotherapy only, including 8 cases (12%) with N3 lesions; 38 patients had oncological reasons for adding neck clearance after radiotherapy, including 12 cases (32%) with N3 lesions; the remaining clinical indicators were not statistically different between the two groups. 22 of the 38 patients (58%) had elective neck clearance (including at least zones II and III, excluding zone V), and 16 patients (42%) had modified neck clearance. The quality of survival was measured using the SF-36 and HNQoL scales, and the quality of survival before and at 1 year after treatment was recorded for comparison. The results showed that after 1 year of treatment, the comparison between the radiotherapy group and the radiotherapy plus neck clearance group was statistically different in all aspects of the SF-36 and NHQoL scales, except for myalgia in the SF-36, suggesting that patients with radiotherapy plus neck clearance had more pain. In addition, there was a statistically significant difference in the mental health aspect of the SF-36 in 22 patients undergoing elective neck clearance compared with 16 patients undergoing modified neck clearance, suggesting better mental health in patients undergoing elective neck clearance.Donatelli-Lassig et al. concluded that radiotherapy plus neck clearance affects only the myalgic pain aspect of survival quality and has no significant effect on other aspects Thus, neck clearance should be performed when oncological indications exist.