Predictive Factors for Gastrostomy Tube Placement in Patients Undergoing Surgery for Upper Aerodigestive Tract Cancers

Abstract

Objectives: 1) Determine which factors of the pre-operative assessment, cancer location, and planned surgical resection are predictive of postoperative need for gastrostomy placement in patients undergoing resection of upper aerodigestive tract cancers. 2) Determine if a pre-operative assessment algorithm can accurately predict need for gastrostomy placement. Methods: Retrospective chart review of all adult patients diagnosed with head and neck cancers that subsequently underwent cancer resection at Wake Forest Baptist Medical Center from 2007-2012. Patient charts were screened for placement of postoperative gastrostomy tube, patient demographics (ie, gender, age), tumor characteristics including size, location, bilaterality, and surgical treatment type. Univariate analysis was run on all patient variables and compared against gastrostomy placement. Results: Gastrostomy tube placement was found to be strongly associated with the patient characteristics of pre-operative weight loss (<.001), history of radiation (.001) and prior dysphagia (.001). Characteristics of the disease including clinical nodal disease (.04) and tongue base tumor location (.05) were also associated. Tracheostomy placement (<.001), supracricoid laryngectomy (.01), floor of mouth resection (.02), total glossectomy (.025) and free flap reconstruction (<.001) were the procedures most significantly associated with gastrostomy tube placement. Post-operative failed swallowing evaluation was most strongly associated with G tube placement (2.8 × 10-22). Conclusions: Preliminary data suggest that certain patient characteristics, tumor features, and types of surgical procedures can predict post-operative gastrostomy tube placement. A risk stratification algorithm can likely be developed given the strength of multiple positive and negative associations between patient and tumor variables.