Risk Factors for Gastric-Tube Dependence Following Tongue Reconstruction

Abstract

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.