In recent years, the evaluation of quality of life (QOL) has become one of the most important indicators of clinical efficacy under the premise of ensuring oncological outcomes and with the transformation of the concept of health. Modern studies of quality of life emphasize not only the integrity of physical functioning, but also social functioning (social adaptation, social support, etc.) and harmony with the environment. During the past 30 years, the evaluation of quality of survival after treatment of malignant tumors has been widely used in clinical practice to provide a comprehensive basis for the screening of improved treatments or interventions, and for decision-making on the allocation of health resources. I. Concept of Quality of Survival Over the years, numerous scholars have explored the concept of quality of survival and proposed hundreds of different understandings of quality of survival. Wan Chonghua introduced 18 concepts of quality of life, such as: ① Levi et al [3] proposed the concept of a comprehensive measure of the individual or group to feel the somatic, psychological, social aspects of the state of good adaptation to life, and the results of the measurements are expressed in terms of a sense of well-being, satisfaction or fulfillment; ② Schipper proposed the disease and treatment of somatic, psychological and social responses to produce a practical, day-to-day functional description. practical, everyday functional description; and (iii) WHO [5] proposes the concept of the experience of individuals in different cultures and value systems of the state of being in relation to their goals, expectations, standards, and concerns. Quality of existence is multidimensional, including physical functioning, psychological functioning, social functioning, and symptoms related to disease or treatment; quality of existence is a subjective evaluation index that should be evaluated by the test subjects themselves; WHO’s concept of quality of existence better reflects this understanding, both by stating that the quality of existence is a subjective experience of all aspects of life, and by defining it under certain cultural contexts and value systems. The basic meanings of quality of life are: (1) quality of life is subjective and comes from the patient’s feelings; (2) quality of life is multidimensional, covering many aspects of the patient’s life; (3) quality of life is dynamic, and it changes with the changes of time and environment. In addition, the subjective evaluation of the quality of survival of people under different cultural systems is also different, so the quality of survival is culturally dependent [2]. Measurement of quality of survival The purpose of quality of survival measurement is to promote the recovery of patients, evaluate the effectiveness of treatment, and predict the response to treatment. The methods of measuring quality of life include questionnaires and face-to-face interviews, etc. Generally speaking, the combination of questionnaires and face-to-face interviews can help to obtain better results. The main contents of quality of life include: ① functional status, including daily life ability, social function, intelligence, emotional status, economic status, etc.; ② patient’s feeling, compared with the functional status, patient’s feeling is subjective; ③ symptoms caused by disease and treatment. The content of the measurement mainly centers on physical, psychological and social aspects to evaluate the quality of survival of patients, and evaluate the impact of diseases and treatments on the physical, psychological and social aspects of patients. 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 and other 6 major aspects; each major aspect is divided into a number of small aspects, a total of 24 small aspects [2]. The form used for the measurement of quality of life is carefully designed, selected through a series of processes such as entry analysis and reflective scale orientation, and organized in a certain format. The selection of each entry is expressed in a certain reflective scale, and thus can be quantified according to a predetermined standardized score, so it is called a scale; some people will only determine the quality of survival of a certain part of the form is also called a scale. According to the different objects, the quality of life measurement scale can be divided into the following three categories: ① universal scale (generic scale): applicable to the determination of the quality of life of the general population, such as SF-36, WHOQOL-100 and other scales; ② disease-specific scale (disease-specific scale): applicable to specific groups of people (patients with diseases and some special populations), which is the most important of all, the quality of life of the general population. Disease-specific scale: applicable to specific groups (disease patients and some special groups), among which FLIC, EORTC QLQ-C30 and other scales are applicable to cancer patients; ③ Domain-specific scale: a scale focusing on a certain field of determining the quality of survival, such as a scale focusing on the evaluation of disease symptoms and side effects of treatment, etc. In recent years, with the increase of tumor cure rate and survival rate, the quality of survival has become more and more important, and the quality of life of cancer patients has been improved. In recent years, with the improvement of tumor cure rate and survival rate, the evaluation of the effect of tumor treatment has also changed from the traditional focus on cure rate, survival rate and functional reconstruction to the emphasis on improving the quality of survival of patients after treatment on the basis of the former three. At present, the development direction of the quality of survival scale is to develop a multidimensional comprehensive questionnaire representing the commonality of different populations, and at the same time attaching a short special questionnaire to assess the quality of survival of different populations; so that the results of the study can be both targeted and comparable. For example, the University of Washington Quality of Survival Head and Neck Scale (UW-QOL) is commonly used for head and neck tumors; the European Organization for Research and Treatment of Cancer (EORTC) can reflect the comprehensive quality of survival with one scale. However, the study of the quality of survival of patients with head and neck tumors is complex, and it is insensitive and unreasonable to evaluate the effect of a certain treatment on the quality of survival by the total or average score of a certain scale; due to a variety of complex factors affecting the quality of survival, it is therefore necessary to introduce multifactorial analysis into the analysis of the quality of survival in order to accurately interpret the effect of different treatments on the quality of survival . In 1989, the Cancer Control Research Society of the Southwest Oncology Organization of the United States suggested that it is appropriate to use the quality of survival assessment for the following cancer patients: ① cancers with poor prognosis; ② cancer treatment problems involving the comparison of different protocols; ③ the evaluation of the effect of adjuvant therapeutic measures for recurrence in patients with breast cancer, melanoma and colorectal cancer; ④ the comparison of the different treatment intensities and times; ⑤ survival time similar to that of survival; ⑤ the comparison of survival time and survival time; ⑤ the comparison of different treatment intensities and times. ⑤ Comparison of various treatment programs with similar survival time but different quality of survival. Surgical treatment of neck metastatic cancer involves the comparison of different treatment options, which may have the same or similar oncologic effects but different effects on survival quality among different surgical modalities, and thus their effects on survival quality have been concerned by many scholars. It has been shown that there is a close relationship between shoulder and neck pain and quality of survival after neck clearance in head and neck cancer patients. Shah et al. showed that the quality of survival of patients after neck dissection improved gradually with postoperative time, and shoulder discomfort and neck constriction had a greater impact on the quality of survival, and the classic neck dissection had a greater impact on the quality of survival than the neck modified and neck selective area dissection, through the use of a self-developed post-neck dissection quality of survival scale and SF-12 questionnaire. Taylor et al. observed that patient’s age, weight, radiation therapy, and type of neck dissection were important factors affecting quality of survival after neck dissection.Gurney measured quality of survival in 87 patients with oral cavity and oropharyngeal cancer using the University of Michigan Head and Neck Specific Quality of Survival Questionnaire, which includes four dimensions: eating, speech, mood, and pain, and it observed that tumor stage, dependence on gastrostomy , complications, recurrence, and mode of treatment affect certain aspects of quality of survival, respectively; 49 (61%) of the 87 patients in this group underwent cervical clearing, and there was no statistically significant difference in all aspects of quality of survival when compared with the other patients who did not undergo cervical clearing, but there was a tendency for patients who did not undergo cervical clearing to score better in terms of eating. Inoue et al. created a self-assessment questionnaire for quality of survival after neck clearing and an upper extremity abduction test to evaluate quality of survival after various types of modified neck clearing. The questionnaire focused on neck and shoulder symptoms, limitations in daily activities, and occupational and leisure activities.Inoue et al. also developed a simple upper-extremity abduction test to evaluate shoulder function associated with neck clearing. The upper extremity abduction test and questionnaire were administered to 74 patients after cervical clearing; these 74 patients underwent cervical clearing 12 months-23 years (mean 36 months) after cervical clearing, 41 had bilateral cervical clearing, and 33 had unilateral cervical clearing; the results showed that patients with preserved spinal paraspinal nerves had better shoulder function, and those with preserved spinal paraspinal nerves and no clearing of zones IV and V scored better in assessing pain, neck tightness scored better, sacrificing the sternocleidomastoid muscle and/or the spinal parasympathetic nerve had a significant adverse effect on daily activities, labor, and leisure, and upper extremity abduction function scores were significantly correlated with responses to questionnaires about shoulder function; the results suggest that modifications to classic neck sweeps can help improve postoperative survival. There is a growing interest in surgical approaches that preserve the cervical sensory nerves during cervical clearing to minimize injury. To investigate the effect of preserving sensory nerves on patient pain and quality of survival during cervical selective sweep or modified cervical sweep, Roh et al [10] retrospectively compared 24 patients who had cervical sensory nerve root branches preserved during cervical sweep with 29 patients who had the nerve branches removed intraoperatively; both groups had spinal parasympathetic nerves preserved intraoperatively, and the two groups were evaluated at 12-34 months postoperatively (mean, 18.7 months) Evaluations were performed; neck and shoulder pain was measured using a visual analog scale for neck sensory and motor function, Beck questionnaire for depression rating, and EORTC-N&H35 questionnaire for quality of survival. The incidence and severity of neck and shoulder pain were reduced in patients with preserved sensory nerves compared with those without; the incidence of abnormal pain, nociceptive hypersensitivity, absence of sensation in the earlobe and lateral neck, and depression was increased in patients without preserved sensory nerves compared with those with preserved sensory nerves; measurement using the EORTC-H&N35 scale showed that patients without preserved sensory nerves had, among the 14 indicators of the scale The scores for pain, social connectedness, sense of illness, and analgesic use were higher in patients with preserved sensory nerves than in patients with preserved sensory nerves, suggesting that patients without preserved sensory nerves 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 areas of permanent neck numbness, and improves postoperative patients’ psychological status and quality of survival. In recent years many patients with head and neck tumors have been treated with simultaneous radiotherapy, and the addition of cervical sweep is an issue that requires careful consideration in some patients with uncontrolled neck tumors after radiotherapy, and evaluation of the quality of survival can help in making this clinical decision. Donatelli-Lassig et al [19] conducted a prospective study of 103 patients with oropharyngeal cancer to compare the quality of survival between patients who received radiotherapy and those who underwent radiotherapy followed by the addition of neck dissection; all 103 patients were selected, first-time patients with stage IV squamous oropharyngeal cancer, and all had a survival period of more than 1 year after treatment; 61 of the 103 patients underwent radiotherapy only, with 8 of them having N3 lesions ( 12%); 38 cases were treated with neck dissection after radiotherapy for oncological reasons, of which 12 cases had N3 lesions (32%); the rest of the clinical indexes were not statistically different between the two groups. Among the 38 patients, 22 cases (58%) underwent elective neck dissection (including at least zones II and III, excluding zone V), and 16 cases (42%) underwent modified neck dissection; the quality of survival was measured using the SF-36 and HNQOL scales, and the quality of survival was recorded before and at 1 year after treatment for comparison. The results showed that after 1 year of treatment, there was a statistically significant difference in all aspects of the SF-36 and NHQoL scales only in the aspect of myalgia in the SF-36 when comparing the radiotherapy group with the radiotherapy plus neck clearing group, suggesting that the pain was worse in the patients who underwent radiotherapy plus neck clearing. In addition, there was a statistically significant difference in the mental health aspect of the SF-36 in patients with 22 cases of cervical elective sweeps compared with patients with 16 cases of modified cervical sweeps, suggesting that patients undergoing cervical elective sweeps had better mental health.Donatelli-Lassig et al. concluded that radiotherapy plus cervical sweeps only affects the myalgia aspect of quality of survival, and does not have a significant effects.