Characterizing postoperative physiologic swallow function following transoral robotic surgery for early stage tonsil, base of tongue, and unknown primary human papillomavirus‐associated squamous cell carcinoma

Abstract

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.

Feeding Tube Placement Following Transoral Robotic Surgery for Oropharyngeal Squamous Cell Carcinoma

“…25 Ottenstein et al described near-universal prophylactic DHT placement (97.6%) and a mean DHT duration of 18.7 days. 26 In their cohort, 65.6% had a postoperative inpatient swallow assessment, although the authors noted that the prolonged presence of a DHT may have impeded swallowing recovery. In almost all our cases, feeding tube requirements were transient.…”

“…Furthermore, the avoidance of intraoperative feeding tubes may improve initial recovery through the avoidance of issues associated with Dobhoff tube (DHT) placement (pain, irritation, greater penetration‐aspiration, worsened pharyngeal clearance) 25 . Ottenstein et al described near‐universal prophylactic DHT placement (97.6%) and a mean DHT duration of 18.7 days 26 . In their cohort, 65.6% had a postoperative inpatient swallow assessment, although the authors noted that the prolonged presence of a DHT may have impeded swallowing recovery.…”

Functional Outcomes in Patients with Human Papillomavirus‐Associated Oropharyngeal Squamous Cell Cancer Treated with Trimodality Therapy

“…41 Because of the incidence of silent aspiration noted post-TORS, this suggests that a clinical bedside swallow evaluation without instrumental assessment will likely be inadequate in identifying aspiration in this population despite reports that aspiration may be rare. 42 There are a number of important limitations to the generalizability of our results. As a single-center study, our selected cohort consists of patients referred to a large tertiary cancer center for primary surgical treatment of advanced disease and may not be representative of other surgical practices.…”

Dysphagia Advances in Head and Neck Cancer

“…These patients may be offered minimally invasive surgery (MIS), using transoral robotic or laser techniques. Although dysphagia is common in the early post-operative period [ 41 , 42 ], by 1 year, patients report similar swallowing function to that at baseline [ 43 ]. Alternatively, patients may be offered radiotherapy, with or without chemotherapy ((C)RT).…”