Is prophylactic percutaneous endoscopic gastrostomy necessary for chemoradiotherapy after total laryngectomy?

Abstract

Abstract Background Post-operative concurrent chemoradiotherapy (CCRT) with cisplatin (CDDP) for locally advanced squamous cell carcinoma of head and neck (LASCCHN) frequently induces severe oral mucositis and dysphagia, which lead to insufficient oral intake and negative impact on treatment outcomes. Therefore, prophylactic percutaneous endoscopic gastrostomy (PEG) has been widely performed. However, PEG placement often causes some complications such as bleeding or abscess. The aim of this study is to evaluate necessity of prophylactic PEG in adjuvant CCRT for high-risk patients with LASCCHN who underwent total laryngectomy. Methods This study retrospectively analyzed 117 LASCCHN patients who underwent either total laryngectomy or other surgery followed by adjuvant CCRT with CDDP at Shizuoka Cancer Center between April 2008 and December 2018. We evaluated the rate of patients unable to obtain sufficient nutrition via oral intake from initiation of CCRT until one year after completion of CCRT, and nutrition-support-free survival. The risk factors for inability of oral intake were determined by using the Cox proportional hazards model. Results Of 117 patients, 25 patients received total laryngectomy and 92 patients received other surgery. The rate of patients unable to obtain sufficient nutrition via oral intake was significantly lower in the total laryngectomy group (16% vs 57%, P Conclusion Prophylactic PEG for adjuvant CCRT may not be necessarily required for the LASCCHN patients who underwent total laryngectomy because of high feasibility of oral intake.