Impact of tongue base mucosectomy on quality-of-life outcomes: systematic review and single-centre experience

Abstract

Purpose Tongue base mucosectomy (TBM) is a well-established procedure in investigating cervical squamous cell carcinoma of occult primary. However, its risks have not been balanced against its benefits with validated tools. Methods A systematic literature review was conducted for reported complications and quality-of-life outcomes following TBM. The complications and quality-of-life outcomes following TBM at our institution are then reported using objective metrics and validated assessment tools, including Performance Status Scale for Head and Neck Cancer Patients (PSS-HNS), University of Washington Quality-of-life Questionnaire (UW-QOL) and M. D. Anderson Dysphagia Inventory (MDADI). Results Eighteen studies met the criteria for inclusion in the systematic review. Of these, 9 addressed swallowing outcomes described in text, without using validated assessment tools. No studies reported taste, speech and pain outcomes after TBM. Post-operative bleeding was not consistently reported. 20 patients underwent robotic TBM at our institution between 2017 and 2023. The primary tumour was identified in 50% (10/20) of cases. The median time to commencing soft diet and median time of NG feeding was 0 days. The median return to normalcy of diet score was 95. Median post-treatment UW-QOL pain and swallowing scores were 100 and 70 respectively. The median speech score was 100, saliva 70, and taste 70. The median normalised MDADI scores were: global 80; emotional 67; functional 80 and physical 65. Conclusions Validated assessment tools better inform patients about treatment options and can help compare post-TBM results across institutions. Our data demonstrates that TBM patients have a functional post-operative swallow, are pain and gastrostomy free, even after adjuvant treatment. Routine post-operative insertion of NG tube is not necessary.