Risk factors for gastrostomy tube dependence in transoral robotic surgery patients

Am J Otolaryngol. 2022 Jan-Feb;43(1):103175. doi: 10.1016/j.amjoto.2021.103175. Epub 2021 Aug 13.

Abstract

Objectives: To determine the rate of gastrostomy tube dependence after transoral robotic surgery (TORS), and to determine which patient or surgical factors increase the likelihood of gastrostomy tube dependence.

Methods: Retrospective chart review of all patients who underwent TORS for oropharyngeal squamous cell carcinoma (OPSCC) at a single institution from January 2011 through July 2016. Patients who underwent TORS for recurrent OPSCC were excluded. Primary outcome was gastrostomy tube (g-tube) dependence. Univariable and multivariable logistic regression were performed to identify risk factors for g-tube dependence at 3-months and 1-year.

Results: A total of 231 patients underwent TORS during the study period. At 3-month follow-up, 58/226 patients (25.7%) required g-tube. At 1-year and 2-year follow-up, 8/203 (3.9%) and 5/176 (2.8%), remained dependent on g-tube, respectively. Advanced T stage (T3) (OR = 6.07; 95% CI, 1.28-28.9) and discharge from the hospital with enteral access (OR = 7.50; 95% CI, 1.37-41.1) were independently associated with increased risk of postoperative gastrostomy tube dependence at 1 year on multivariable analysis.

Conclusions: Long-term gastrostomy tube dependence following TORS is rare, particularly in patients that receive surgery alone. Patients with advanced T stage tumors have poorer functional outcomes. Early functional outcomes, as early as discharge from the hospital, are a strong predictor for long-term functional outcomes.

Keywords: Functional outcomes; Gastrostomy tube; Nasogastric tube; Oropharyngeal cancer; Transoral robotic surgery.

MeSH terms

  • Adult
  • Aged
  • Dependency, Psychological*
  • Female
  • Follow-Up Studies
  • Gastrostomy / methods*
  • Gastrostomy / psychology*
  • Humans
  • Intubation, Gastrointestinal / methods*
  • Intubation, Gastrointestinal / psychology*
  • Male
  • Middle Aged
  • Neoplasm Staging
  • Oral Surgical Procedures / methods*
  • Oropharyngeal Neoplasms / pathology
  • Oropharyngeal Neoplasms / psychology*
  • Oropharyngeal Neoplasms / surgery*
  • Postoperative Period
  • Risk Factors
  • Robotic Surgical Procedures / methods*
  • Squamous Cell Carcinoma of Head and Neck / pathology
  • Squamous Cell Carcinoma of Head and Neck / psychology*
  • Squamous Cell Carcinoma of Head and Neck / surgery*
  • Time Factors
  • Treatment Outcome