Faculty Collaboration Database

Predictors of swallow function after transoral surgery for locally advanced oropharyngeal cancer. Laryngoscope 2020 Jan;130(1):94-100

Date

04/09/2019

Pubmed ID

30957243

Pubmed Central ID

PMC8932014

DOI

10.1002/lary.27856

Scopus ID

2-s2.0-85064081389 (requires institutional sign-in at Scopus site)   8 Citations

Abstract

OBJECTIVE: Transoral surgery (TOS) for oropharyngeal carcinoma (OPC) is steadily becoming more routine. Expected posttreatment swallow function is a critical consideration for preoperative counseling. The objective of this study was to identify predictors of swallow dysfunction following TOS for advanced tumor (T)-stage (T3-T4) OPC.

METHODS: A retrospective review from 1997 to 2016 at a single institution was performed. Eighty-two patients who underwent primary transoral resection of locally advanced OPCs with at least 1 year of postoperative follow-up were included. The primary outcome measure was swallow function, as measured by the Functional Outcomes Swallowing Scale (FOSS) at 1 year postoperatively. Operative reports were reviewed, and the extent of resection and type of reconstruction were documented. Conjunctive consolidation was then performed to incorporate multiple variables and their impact on swallow function into a clinically meaningful classification system.

RESULTS: Fifty-six patients (68%) had acceptable swallowing at 1 year. T4 tumor stage and receipt of adjuvant chemoradiation therapy (CRT) were strongly associated with poor swallowing but did not reach statistical significance. Only base of tongue (BOT) resection ≥50% (odds ratio [OR] 3.19, 95% confidence interval [CI] 1.21-8.43) and older age (OR 1.06, 95% CI 1.00-1.12) were significantly associated. Utilizing T-stage, adjuvant CRT, and BOT resection, a conjunctive consolidation was performed to develop a classification system for swallow dysfunction at 1 year.

CONCLUSION: This study provides risk stratification for swallow function at 1 year following primary transoral resection of locally advanced OPCs. BOT resection ≥50%, especially when coupled with T4 tumor stage or adjuvant CRT, was associated with poor long-term swallow outcomes.

LEVEL OF EVIDENCE: 3 Laryngoscope, 130:94-100, 2020.

Author List

Gross JH, Townsend M, Hong HY, Miller E, Kallogjeri D, Zenga J, Pipkorn P, Jackson RS, Haughey B, Rich JT

Author

Joseph Zenga MD Assistant Professor in the Otolaryngology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aged
Chemotherapy, Adjuvant
Deglutition Disorders
Female
Humans
Male
Middle Aged
Missouri
Neoplasm Staging
Oropharyngeal Neoplasms
Postoperative Complications
Retrospective Studies