Is there a role of functional endoscopic evaluation of swallowing (FEES) in aiding tracheotomy decannulation post oral cancer surgery?

Abstract

e18523 Background: A significant proportion of patients with oral cancer require perioperative tracheotomy. The altered oral anatomy post surgery significantly impairs the first and second stages of swallowing, resulting in swallowing dysfunction and potential aspiration. There is no priordata on utilization of FEES or other objective tools to predict successful tracheotomy decannulation in patients with oral cancer. Methods: This constituted a retrospective analysis of 237 patients with oral cancer treated at our institution between Feb 2017 and Dec 2019. Seventy two (30.4%)patients underwent perioperative tracheotomy. Post surgery,after excluding patients who were not considered candidates for early decannulation, 48 (65.7%) underwent FEES with the endpoint of tracheotomy decannulation. The number of FEES procedures required for decannulation was correlated with patient and disease-specific variables utilizing Chi square analysis. Results: The rate of successful decannulation was 100%. The mean number of days from tracheotomy to decannulation was 24.9. Thirty two (66.7%) patients underwent decannulation post the first FEES, notablyupon documentation of no penetration or aspiration to three bolus consistencies. However, 33.3% patients needed swallowing therapy followed by a second (18.8%) or a third (14.6%) FEES before they could be decannulated (late decannulation). No patients required a repeat tracheotomy. A significantly higher proportion of individuals at or younger than median age were decannulated earlier, compared with individuals above median age ( p= 0.01). There was no statistically significant difference between early (T1/2) and advanced (T3/4) primary lesions and timing of decannulation ( p= 0.83). The presence of comorbid diabetes mellitus did not correlate with decannulation timing ( p= 0.81). Conclusions: FEES constitutes a reliable, minimally invasive and cost-effective tool to aid successful decannulation across all stages of oral cancer. It may be indicated especially in older individuals. It helps guide swallowing therapy, and thus potentially augments quality of life by tailoring serial evaluations to aid early decannulation.