Feeding Tube Placement Following Transoral Robotic Surgery for Oropharyngeal Squamous Cell Carcinoma

Abstract

Objective To identify factors that may predict the need for feeding tubes in patients undergoing transoral robotic surgery (TORS) in the perioperative setting. Study Design Retrospective chart review. Setting Academic tertiary center. Methods A retrospective series of patients undergoing TORS for oropharyngeal squamous cell carcinoma (OPSCC) was identified between October 2016 and November 2019 at a single tertiary academic center. Patient data were gathered, such as frailty information, tumor characteristics, and treatment, including need for adjuvant therapy. Multiple logistic regression was performed to identify factors associated with feeding tube placement following TORS. Results A total of 138 patients were included in the study. The mean age was 60.2 years (range, 37-88 years) and 81.9% were male. Overall 82.9% of patients had human papilloma virus–associated tumors, while 28.3% were current or former smokers with a smoking history ≥10 pack-years. Eleven patients (8.0%) had a nasogastric or gastrostomy tube placed at some point during their treatment. Five patients (3.6%) had feeding tubes placed perioperatively (<4 weeks after TORS), of which 3 were nasogastric tubes. Six patients (4.3%) had feeding tubes placed in the periadjuvant treatment setting for multifactorial reasons; 5 of which were gastrostomy tubes. Only 1 patient (0.7%) was gastrostomy dependent 1 year after surgery. Multiple logistic regression did not demonstrate any significant predictive variables affecting perioperative feeding tube placement following TORS for OPSCC. Conclusions Feeding tubes are seldom required after TORS for early-stage OPSCC. With appropriate multidisciplinary planning and care, patients may reliably avoid the need for feeding tube placement following TORS for OPSCC.

National Trends in 30-Day Readmission Following Transoral Robotic Surgery for Oropharyngeal Squamous Cell Carcinoma

“…Readmission due to electrolyte abnormalities or digestive issues was seen in 4.6% of this cohort. Consistent with other studies, we found that the majority of patients receiving TORS did not require feeding tube placement . Still, it may be beneficial to consider prophylactic measures to mitigate the risk of poor oral intake following TORS, such as routine assessment of preoperative and postoperative swallowing function to risk stratify patients, placement of temporary feeding tubes during the index admission for those with decreased laryngeal function, routine use of perioperative corticosteroids, or enrollment in Enhanced Recovery After Surgery pathways .…”

Revisiting Feeding Tube Utilization in Oropharynx Cancer: 6‐Year Prospective Registry Analysis

“…When an NGT is placed, close postoperative coordination with the dietitian and SLP may expedite nutritional and swallowing recovery. 22,37 We observed higher G-tube rates and decreased removal probability in patients with higher baseline DIGEST grades and lower PSSHN-Diet and MDADI composite scores. These findings suggest that pretreatment swallowing dysfunction is associated with increased likelihood and duration of FT placement.…”

“…Institutional practices may change, as recent evidence suggests NGT placement during TORS may not be necessary. 22 Regardless, these results inform FT outcomes following this practice. When an NGT is placed, close postoperative coordination with the dietitian and SLP may expedite nutritional and swallowing recovery.…”

“…HPV-associated tumors now account for approximately 70% of all OPC cases in the United States. 9,19,21,22 Transoral robotic surgery (TORS) has demonstrated decreased weight loss and G-tube placement when compared to nonsurgical treatment. 23,24 Swallowing rehabilitation is incorporated proactively, with swallowing exercises and oral intake demonstrating improved mobility, shorter FT duration, and increased recovery to normal diet after treatment.…”

Current Therapeutic Strategies in Patients with Oropharyngeal Squamous Cell Carcinoma: Impact of the Tumor HPV Status

“…If surgery is selected, a transoral approach should be preferred. Indeed, minimally invasive surgery (TORS and elective neck dissection or SNB) has demonstrated promising results in terms of swallowing function and could be an interesting option to avoid late side-effects of RT [74,75]. Several phase III clinical trials (Best Of and TORPHYNX; ClinicalTrials.gov Identifiers: NCT02984410 and NCT04224389, respectively) comparing TORS and RT in terms of swallowing function in patients with early-stage OPSCC are currently ongoing.…”