Factors associated with gastrostomy tube dependence following salvage total laryngectomy with microvascular free tissue transfer

Head Neck. 2019 Apr;41(4):865-870. doi: 10.1002/hed.25367. Epub 2018 Dec 14.

Abstract

Background: Following salvage total laryngectomy (STL) with microvascular-free tissue transfer (MFTT), patients are at high risk for swallowing dysfunction, but risk factors for persistent gastrostomy tube (G-tube) dependence are unknown.

Methods: Retrospective review of 33 patients who underwent STL with MFTT.

Results: A total oral diet was achieved by 81% of patients with ≥6 months of postoperative follow-up. Approximately 27% of patients were G-tube dependent preoperatively with 67% achieving a total oral diet postoperatively. Factors associated with persistent G-tube dependence included pT4 tumor, pN2+ status, more extensive pharyngectomy, and re-irradiation. Strictures occurred in 30% of patients and were associated with more extensive pharyngectomy and tubed reconstruction.

Conclusions: For patients undergoing STL with MFTT, the majority of patients achieve a total oral diet regardless of their preoperative swallowing function. Advanced-stage recurrent tumors and increased extent of pharyngectomy contribute to poorer swallowing outcomes.

Keywords: gastrostomy; laryngectomy; microvascular; reconstruction; swallow.

MeSH terms

  • Aged
  • Cohort Studies
  • Confidence Intervals
  • Deglutition / physiology
  • Deglutition Disorders / etiology*
  • Deglutition Disorders / physiopathology
  • Enteral Nutrition / methods
  • Female
  • Follow-Up Studies
  • Gastrostomy / methods*
  • Humans
  • Laryngeal Neoplasms / mortality
  • Laryngeal Neoplasms / pathology
  • Laryngeal Neoplasms / surgery*
  • Laryngectomy / adverse effects
  • Laryngectomy / methods*
  • Male
  • Middle Aged
  • Odds Ratio
  • Reconstructive Surgical Procedures / methods*
  • Retrospective Studies
  • Risk Assessment
  • Salvage Therapy / methods*
  • Surgical Flaps / blood supply
  • Surgical Flaps / transplantation
  • Time Factors
  • Treatment Outcome