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Predictors of gastrostomy tube dependence in surgically managed oropharyngeal squamous cell carcinoma
Author(s) -
Varma Vivek R.,
Eskander Antoine,
Kang Stephen Y.,
Kumar Bhavna,
Brown Nicole V.,
Zhao Songzhu,
Brock Guy,
Agrawal Amit,
Carrau Ricardo L.,
Old Matthew O.,
Ozer Enver,
Rocco James W.,
Schuller David E.,
Dziegielewski Peter T.,
Cipolla Michael J.,
Teknos Theodoros N.
Publication year - 2019
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.27290
Subject(s) - medicine , transoral robotic surgery , perioperative , surgery , gastrostomy tube , glossectomy , gastrostomy , feeding tube , stage (stratigraphy) , odds ratio , adjuvant , tongue , paleontology , pathology , biology
Objectives To elucidate predictive factors in the perioperative period resulting in gastrostomy tube (G‐tube) dependence for patients undergoing primary surgical treatment of oropharyngeal squamous cell carcinoma (OPSCC) in the modern era. Methods Two hundred and thirty patients with known OPSCC treated with primary surgery were screened and selected from a retrospective database spanning from 2002 to 2012 at The Ohio State University Wexner Medical Center (Columbus, Ohio), with univariable and multivariable logistic regression modeling used to determine independent predictive factors resulting in G‐tube dependence (defined as tube persistence/presence 1 year after surgery). Results Surgical approach, baseline characteristics, tumor (T)‐nodal‐metastasis stage, human papillomavirus status, extent of tissue resected, surgical complications, reconstructive technique, preoperative G‐tube presence, and adjuvant treatment were recorded. Patients undergoing open surgery for OPSCC without adjuvant treatment had 42.9% G‐tube dependence (44.6% with adjuvant chemoradiation [CRT]) compared to 0% for those undergoing transoral nonrobotic surgery (8.1% with adjuvant CRT) and 0% for those undergoing transoral robotic surgery (10.3% with adjuvant CRT). In multivariable analysis, greater than 25% of the oral tongue resected (odds ratio [OR] 12.29; P = 0.03), an open surgical approach (OR 5.72; P < 0.01) and T3/T4 tumor stage (OR 2.84; P = 0.02) were independent and significant predictors of G‐tube dependence. Conclusion Surgical approach, advanced tumor stage, and oral tongue resection may influence the development of nutritional dependence for surgically treated patients with OPSCC. Level of Evidence 4 Laryngoscope , 129:415–421, 2019