Nasogastric tube feeding after transoral robotic surgery for oropharynx carcinoma

Plonowska, Karolina; Ochoa, Edgar; Zebolsky, Aaron L.; Patel, Neil N.; Hoppe, Kathryn; Ha, Patrick K.; Heaton, Chase M.; Ryan, William R.

doi:10.1016/j.amjoto.2020.102857

Cited by 6 publications

(8 citation statements)

References 19 publications

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“…Although many factors influence feeding tube placement, we believe that our low rate in the postoperative period is in part due to our institution’s close collaboration with an SLP in the pre‐ and postoperatitve setting. In a recent retrospective study of 95 patients undergoing TORS, Plonowska et al reported an intraoperative feeding tube placement rate of 49.5% and a postoperative enteral feeding rate of 23.2% 24 . We believe that our perioperative feeding tube requirement of 3.6% compares favorably to other institutions thanks to careful patient selection and comprehensive preoperative counseling and postoperative assessments.…”

Section: Discussionmentioning

confidence: 64%

“…In a recent retrospective study of 95 patients undergoing TORS, Plonowska et al reported an intraoperative feeding tube placement rate of 49.5% and a postoperative enteral feeding rate of 23.2%. 24 We believe that our perioperative feeding tube requirement of 3.6% compares favorably to other institutions thanks to careful patient selection and comprehensive preoperative counseling and postoperative assessments. This gives our patients appropriate expectations and techniques to allow safe postoperative swallowing to expedite their functional recovery.…”

Section: Discussionmentioning

confidence: 84%

“…However, the mean specimen volume was slightly larger for patients who required feeding tube placement in the perioperative period. Other studies have shown a similar association between tumor volume on computed tomography scan and the development of postoperative TORS dysphagia 24 , 31 . Given the retrospective nature of this review with tumor quantification from pathology reports, a lack volume accuracy may have prevented us from seeing a significant difference.…”

Section: Discussionmentioning

confidence: 87%

“…Other studies have shown a similar association between tumor volume on computed tomography scan and the development of postoperative TORS dysphagia. 24,31 Given the retrospective nature of this review with tumor quantification from pathology reports, a lack volume accuracy may have prevented us from seeing a significant difference. Smaller specimens may not meet volume thresholds after which swallowing function is compromised.…”

Section: Discussionmentioning

confidence: 99%

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

Feng¹,

Holcomb²,

Abt³

et al. 2021

Otolaryngol.--head neck surg.

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Objective To identify factors that may predict the need for feeding tubes in patients undergoing transoral robotic surgery (TORS) in the perioperative setting. Study Design Retrospective chart review. Setting Academic tertiary center. Methods A retrospective series of patients undergoing TORS for oropharyngeal squamous cell carcinoma (OPSCC) was identified between October 2016 and November 2019 at a single tertiary academic center. Patient data were gathered, such as frailty information, tumor characteristics, and treatment, including need for adjuvant therapy. Multiple logistic regression was performed to identify factors associated with feeding tube placement following TORS. Results A total of 138 patients were included in the study. The mean age was 60.2 years (range, 37-88 years) and 81.9% were male. Overall 82.9% of patients had human papilloma virus–associated tumors, while 28.3% were current or former smokers with a smoking history ≥10 pack-years. Eleven patients (8.0%) had a nasogastric or gastrostomy tube placed at some point during their treatment. Five patients (3.6%) had feeding tubes placed perioperatively (<4 weeks after TORS), of which 3 were nasogastric tubes. Six patients (4.3%) had feeding tubes placed in the periadjuvant treatment setting for multifactorial reasons; 5 of which were gastrostomy tubes. Only 1 patient (0.7%) was gastrostomy dependent 1 year after surgery. Multiple logistic regression did not demonstrate any significant predictive variables affecting perioperative feeding tube placement following TORS for OPSCC. Conclusions Feeding tubes are seldom required after TORS for early-stage OPSCC. With appropriate multidisciplinary planning and care, patients may reliably avoid the need for feeding tube placement following TORS for OPSCC.

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Section: Discussionmentioning

confidence: 64%

Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

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

Feng¹,

Holcomb²,

Abt³

et al. 2021

Otolaryngol.--head neck surg.

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“…Nasogastric tube feeding is performed for 5–10 days postoperatively, and semiliquid feeding is arranged for the following week. Although the discomfort of nasogastric tube feeding is sometimes challenging, it is beneficial for the healing of the laryngopharyngeal wound and reduces the risk of infection [ 29 ]. Ultrasonic nebulization should be performed postoperatively to relieve the oropharyngeal discomfort and edema [ 30 ].…”

Section: Main Textmentioning

confidence: 99%

Preoperative management and postoperative complications associated with transoral decompression for the upper cervical spine

Wang

Feng

et al. 2022

BMC Musculoskelet Disord

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Purpose This review aimed to describe the preoperative management and postoperative complications associated with transoral decompression of the upper cervical spine, and to clarify the risk factors, related issues and complication management. Methods Studies on transoral decompression for the upper cervical spine were reviewed systematically. The preoperative management and postoperative complications associated with transoral decompression for upper cervical deformities were analyzed. Results Evidence suggests that preoperative management in patients undergoing transoral decompression for the upper cervical spine is closely related to the occurrence of postoperative complications. Hence, preoperative surgical planning, preoperative preparation, and oral nursing care should be seriously considered in these patients. Moreover, while being established as an effective and safe method, transoral decompression is associated with several postoperative complications, which could be prevented by elaborate preoperative management, improved surgical skills, and appropriate precautionary measures. Conclusions The effectiveness and safety of transoral decompression has been improved by the constant development of operative techniques and advanced auxiliary diagnostic and therapeutic methods, with the understanding of the anatomical structure of the craniocervical joint. Therefore, the incidence rates of postoperative complications have decreased. The application of individualized anterior implants and less-invasive endoscopic endonasal approach has improved the effectiveness of transoral decompression and reduced the associated complications.

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Risk of Pathologic Extranodal Extension and Other Adverse Features After Transoral Robotic Surgery in Patients With HPV-Positive Oropharynx Cancer

Zebolsky

George

Gulati

et al. 2021

JAMA Otolaryngol Head Neck Surg

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IMPORTANCEUnderstanding patient-specific risk of adverse histopathologic findings after primary surgery for human papillomavirus (HPV)-positive oropharynx squamous cell carcinoma (OPSCC) may help guide patient consultations.OBJECTIVE To determine the likelihood of adverse histopathologic features that may indicate adjuvant radiotherapy or chemoradiotherapy after primary surgery for HPV-positive OPSCC according to 2021 National Comprehensive Cancer Network guidelines. DESIGN, SETTING, AND PARTICIPANTSThis retrospective cohort study was performed at a single academic tertiary care center. Of 258 patients who underwent transoral robotic surgery (TORS) from March 1, 2012, to March 1, 2021, 136 consecutive, treatment-naive patients with HPV-positive OPSCC without obvious clinical extranodal extension (ENE) who underwent definitive TORS and neck dissection were included in the analysis. Indications for surgical treatment included non-deeply infiltrative oropharynx tumors, minimal soft palate involvement, and low suspicion for pathologic ENE.EXPOSURES Primary site TORS with neck dissection. MAIN OUTCOMES AND MEASURESThe primary outcomes were the adverse histopathologic features of pathologic ENE and positive surgical margins (PSM) that are indications for possible adjuvant chemoradiotherapy. Outcomes were compared among varying American Joint Committee on Cancer 7th edition (AJCC-7) T and N categories and patient clinical characteristics. RESULTSOf the 136 patients included in the analysis (113 men [83.1%]; median age, 63 [interquartile range, 55-70] years), 109 (80.1%) had at least 1 indication for possible adjuvant radiotherapy. Twenty-seven patients (19.9%) had pathologic ENE and 10 (7.3%) had PSM. Thirty-four patients (25.0%) had pathologic ENE and/or PSM, whereas 3 (2.2%) had both. Age, smoking history, history of alcohol consumption, and clinical T category were not associated with pathologic ENE, PSM, lymphovascular invasion, perineural invasion, or pN2 category or greater. The proportion of pathologic ENE varied by clinical N category: 0 of 16 for cN0, 8 of 48 (16.7%) for cN1, 3 of 23 (13.0%) for cN2a, and 16 of 45 (35.6%) for cN2b. Compared with patients with cN1-cN2a disease, patients with cN2b disease had higher odds of pathologic ENE (odds ratio, 3.01; 95% CI, 1.14-8.10). Clinical and pathologic N category were concordant in 77 patients (56.6%), whereas 42 (30.9%) were upstaged and 17 (12.5%) were downstaged. CONCLUSIONS AND RELEVANCEIn this cohort study, approximately one-quarter of carefully selected patients with HPV-positive OPSCC without obvious clinical ENE undergoing primary surgery had pathologic ENE and/or PSM. Patients with AJCC-7 cT0-cT2 cN0-cN2b disease, especially cN0-cN2a, without signs of clinical ENE may represent appropriate candidates for primary surgery when avoidance of adjuvant chemotherapy and/or reduction of adjuvant radiotherapy dose/extent are the goals.

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Nasogastric tube feeding after transoral robotic surgery for oropharynx carcinoma

Cited by 6 publications

References 19 publications

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

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

Preoperative management and postoperative complications associated with transoral decompression for the upper cervical spine

Risk of Pathologic Extranodal Extension and Other Adverse Features After Transoral Robotic Surgery in Patients With HPV-Positive Oropharynx Cancer

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