Functional outcomes and tracheostomy dependence following salvage oropharyngeal surgery.

PURPOSE

: Salvage surgical treatment of oropharyngeal cancer is associated with significant morbidity. We aim to identify predictive factors of functional outcomes to improve patient selection and counseling when contemplating salvage oropharyngectomy.

METHODS

: Patients with a history of radiation requiring salvage oropharyngeal surgery were identified. Primary outcomes were determined at one year post-salvage surgery and included Gastric tube (G-tube) dependence, dietary restrictions, tracheostomy dependence, and speech intelligibility. Multivariate analyses were performed to identify predictors of the primary outcomes.

RESULTS

: At one year, 45% (22/49) of patients had a G-tube, 68% (33/48) had dietary restrictions, 10% (5/49) remained tracheostomy dependent, and 15% (4/26) had difficulty with speech intelligibility. On univariate analysis, pre-operative G-tube (83% vs. 40%, p=0.04), reconstruction with a free flap (54% vs. 0%, p=0.005), and bony resection (69% vs. 36%, p=0.04) were significantly associated with G-tube dependence at one year. On multivariate analysis, concurrent bony resection remained a significant predictor of G-tube dependence (HR 5.4, 95% CI 1.2–24, p=0.03). Predictors of dietary restriction included free-flap reconstruction (78% vs. 25%, HR 0.13, 95% CI 0.02–0.87, p=0.04) and recurrence after two years (85% vs. 48%, HR 4.9, 95% CI 1.2–21, p=0.03). Supraglottic laryngectomy was significantly associated with tracheostomy dependence on univariate (67% vs. 7%, p=0.001) and multivariate analysis (HR 44.4, 95% CI 2.0–986, p=0.02).

CONCLUSION AND RELEVANCE

: Functional outcomes are suboptimal after salvage oropharyngectomy. Specific patient and disease factors are independently associated with worse speech and swallowing outcomes and may aid in pre-operative patient selection, risk stratification, and shared decision-making.