Factors Leading to Gastrostomy Tube and Tracheostomy Requirements in Patients Treated Initially With Radiotherapy and Salvaged With Surgery and Free Flap Reconstruction

Abstract

ObjectivePatients with recurrent oropharyngeal cancer can achieve survival benefits from surgical salvage, and often require simultaneous free‐flap reconstruction. Resection and reconstruction can impact function, leading to tube dependence. Primary objective: describe rates of tracheostomy and gastrostomy tube dependence after oropharyngeal resection and free flap after prior radiation. Secondary objective: evaluate patient, tumor, and treatment factors associated with tube dependence.Study DesignRetrospective, multi‐institutional cohort study. Patients treated from 2003 to 2020. Average follow‐up 21.4 months.SettingFive tertiary care centers.MethodsConsecutive cohort of patients undergoing resection and simultaneous free‐flap reconstruction for oropharyngeal squamous cell carcinoma after head and neck radiation. Primary outcomes: gastrostomy tube dependence and tracheostomy or tracheostoma 1 year after surgery. Univariable and multivariable logistic regression were performed to identify factors associated with dependence.Results89 patients underwent oropharyngectomy and free‐flap reconstruction; 18 (20%) underwent total laryngectomy as part of tumor extirpation. After surgery, 51 patients (57%) lived 12 months. Among patients alive at 12 months, 22 (43%) were at least partially‐dependent on gastrostomy tube, and 15 (29%) had either tracheostomy or tracheostoma. On multivariable analysis, extensive glossectomy (OR 16.6, 95% CI 1.83–389, p = 0.026) and total laryngectomy (OR 11.2, 95% CI 1.71–105, p = 0.018) were associated with long‐term gastrostomy tube. No factors were associated with long‐term tracheostomy on multivariable analysis.ConclusionEven among long‐term survivors after salvage resection and free‐flap reconstruction, rates of tube dependence are significant. This multi‐institutional review is the largest such study to the date and may help inform shared decision‐making.Level of Evidence4 Laryngoscope, 133:2141–2147, 2023