Dysphagia profiles after primary transoral robotic surgery or radiation for oropharyngeal cancer: A registry analysis

Objective To describe the physiologic swallowing impairments (MBSImP™©) associated with safety/efficiency impairments (DIGEST safety /DIGEST efficiency grades) at 3–6 months after transoral robotic surgery (TORS) or radiation therapy (RT). Study Design Secondary analysis of registry data. Setting Single, academic institution. Methods Two hundred and fifty‐seven patients with HPV+ oropharynx cancer were stratified by primary treatment (75 TORS, 182 RT). Modified barium swallow studies were analyzed at baseline and 3–6 months using MBSImP scores and DIGEST safety /DIGEST efficiency grades. DIGEST safety /DIGEST efficiency grades and MBSImP were compared groupwise and associations between DIGEST safety /DIGEST efficiency grades and MBSImP were explored by ordinal logistic regression. Exploratory analyses were stratified by multimodality treatment. Results Neither DIGEST safety /DIGEST efficiency differed significantly between groups at baseline or 3–6 months. Laryngeal vestibule closure was impaired more frequently in the RT group (RT: 41% vs. TORS: 27%; p = 0.02) while the TORS group had significantly more pharyngeal contraction impairment (63%; p < 0.001) compared to RT at 3–6 months. Conclusion The results suggest a focal injury associated with DIGEST safety /DIGEST efficiency post‐TORS in contrast to a low‐level diffuse physiologic impairment associated with post‐RT dysphagia.