Baseline swallowing measures predict recovery at 6 weeks after transoral robotic surgery for head and neck cancer

Abstract

Objectives

To explore whether pre-treatment swallowing measures predict swallowing recovery at 6 weeks after transoral robotic surgery.

Design

Prospective cohort study.

Setting

Tertiary care cancer centre in the United Kingdom.

Participants

51 consecutive patients undergoing transoral robotic surgery for head and neck cancer, between April 2013 and February 2015.

Main outcome measures

Swallowing function assessed by Performance Status Scale (PSS) Normalcy of Diet, timed water swallow test capacity scores (WST), and duration of tube feeding.

Results

The primary site distribution was as follows: 21 oropharynx, 8 larynx, 6 mucosectomy and 6 hypopharynx. T stages included 7 staged Tx, 21 T1-T2 tumours and one T3 tumour. Moderate to severe comorbidity was found in 45/51 patients. Mean PSS score was 83 (S.D. 27.54); mean WST score was 11.14 (S.D. 7.97). Most patients (73%) required tube feeding post-operatively, with mean tube feed duration of 18.08 days (S.D. 17.91); 76% resumed oral intake by 6 weeks. Pre-treatment swallow tests showed moderate negative correlation with tube feeding duration: PSS (rho 0-.430 P=.003); WST (rho 0-.503 P = 0.002).

Conclusions

The majority of TORS patients resume oral intake by 6 weeks. This study shows that impaired swallowing prior to surgery correlates with post-operative duration of tube feeding and strengthens the evidence for the utility of these measures in this clinical setting.

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