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Characterizing p ostoperative physiologic swallow function following transoral robotic surgery for early stage tonsil, base of tongue, and unknown primary human papillomavirus ‐associated squamous cell carcinoma
Author(s) -
Ottenstein Lauren,
Cornett Hannah,
Switchenko Jeffrey M.,
Nathan Meghana,
Thomas Susan,
Gillespie Amanda I.,
McColloch Nancy,
Barrett Tiffany,
Studer Matthew B.,
Brinkman Meghan,
Kaka Azeem S.,
Boyce Brian J.,
Ferris Robert L.,
Aiken Ashley H.,
ElDeiry Mark,
Beitler Jonathan J.,
Patel Mihir R.
Publication year - 2021
Publication title -
head and neck
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.012
H-Index - 127
eISSN - 1097-0347
pISSN - 1043-3074
DOI - 10.1002/hed.26632
Subject(s) - transoral robotic surgery , medicine , swallowing , tonsil , dysphagia , gastroenterology , retrospective cohort study , oncology , tongue , surgery , pathology
Background Data objectively evaluating acute post‐transoral robotic surgery (TORS) swallow function are limited. Our goal was to characterize and identify clinical variables that may impact swallow function components 3 weeks post‐TORS. Methods Retrospective cohort study. Pre/postoperative use of the Modified Barium Swallow Impairment Profile (MBSImP) and Penetration‐Aspiration Scale (PAS) was completed on 125 of 139 TORS patients (2016–2019) with human papillomavirus (HPV)‐associated oropharyngeal squamous cell carcinoma. Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) scores were retrospectively calculated. Uni/multivariate analysis was performed. Results Dysfunctional pre‐TORS DIGEST scores were predictive of post‐TORS dysphagia ( p = 0.015). Pre‐TORS MBSImP deficits in pharyngeal stripping wave, swallow initiation, and clearing pharyngeal residue correlated with airway invasion post‐TORS based on PAS scores ( p = 0.012, 0.027, 0.048, respectively). Multivariate analysis of DIGEST safety scores declined with older age ( p = 0.044). Odds ratios (ORs) for objective swallow function components after TORS were better for unknown primary and tonsil primaries compared to base of tongue (BOT) (OR 0.35–0.91). Conclusions Preoperative impairments in specific MBSImP components, older patients, and BOT primaries may predict more extensive recovery in swallow function after TORS.