Division of Plastic and Reconstructive Surgery, National Cancer Center Hospital, Tokyo, Japan.
Ann Surg Oncol. 2012 Jul;19(7):2320-6. doi: 10.1245/s10434-012-2298-2. Epub 2012 Mar 7.
Postoperative dysphagia is not uncommon following significant glossectomy with laryngeal preservation. To develop effective treatments for this patient population, risk factors for postoperative dysphagia must be accurately identified. The objective of this retrospective study was to identify independent risk factors for dysphagia following microvascular tongue reconstruction.
We performed a retrospective chart review of 222 patients who had undergone microvascular tongue reconstruction after significant glossectomy with laryngeal preservation. The variables examined were age, sex, preoperative body mass index (BMI), history of radiotherapy (RT) to the neck, smoking, alcohol drinking, clinical tumor stage, extent of the defect (tongue, mandible, soft palate, and neck dissection), and postoperative RT. Postoperative dysphagia was defined as gastric-tube dependence for nutrition at the time of evaluation. Possible risk factors for gastric-tube dependence were subjected to univariate analysis and multivariate logistic regression.
A total of 33 patients (14.9%) had dysphagia at the time of evaluation. Multivariate logistic regression analysis identified age≥70 years, BMI<18.5 kg/m2, and, most significantly, postoperative RT as significant risk factors for gastric-tube dependence after tongue reconstruction. Clinical tumor stage (stage IV/recurrence), subtotal or total glossectomy and full-thickness resection of the soft palate were identified as significant factors on univariate analysis but not on multivariate analysis.
The present study has identified age≥70 years, BMI<18.5 kg/m2, and, especially, postoperative RT as significant risk factors for gastric-tube dependence after tongue reconstruction. These factors should be considered when selecting treatments for patients with advanced oral and oropharyngeal cancers.
喉保留的大范围舌切除术后吞咽困难并不少见。为了为这一患者群体开发有效的治疗方法，必须准确识别术后吞咽困难的危险因素。本回顾性研究的目的是确定微血管舌重建后吞咽困难的独立危险因素。
我们对 222 例因喉保留的大范围舌切除术后接受微血管舌重建的患者进行了回顾性图表分析。检查的变量包括年龄、性别、术前体重指数（BMI）、颈部放疗（RT）史、吸烟、饮酒、临床肿瘤分期、缺损范围（舌、下颌骨、软腭和颈部清扫术）以及术后 RT。术后吞咽困难定义为评估时依赖胃管进行营养。将可能的胃管依赖危险因素进行单因素分析和多变量逻辑回归分析。
共有 33 例（14.9%）患者在评估时存在吞咽困难。多变量逻辑回归分析确定年龄≥70 岁、BMI<18.5kg/m2，以及最重要的术后 RT 是舌重建后胃管依赖的显著危险因素。临床肿瘤分期（IV 期/复发）、次全或全舌切除术和软腭全层切除术在单因素分析中被确定为显著因素，但在多因素分析中未被确定。
本研究确定了年龄≥70 岁、BMI<18.5kg/m2，尤其是术后 RT 是舌重建后胃管依赖的显著危险因素。在为晚期口腔和口咽癌患者选择治疗方法时应考虑这些因素。
