Otolaryngology–Head and Neck Surgery Outcomes
Head and Neck Surgery
Oropharyngeal squamous cell carcinoma (OPSCC) is one of the most common forms of head and neck cancer in the United States. The majority of cases are associated with the human papilloma virus (HPV) and have excellent cure rates, which has motivated surgeons in the Division of Head and Neck Surgery to optimize functional treatment outcomes for OPSCC.
Incidence of feeding tubes in transoral robotic surgery
Surgeons are using transoral robotic surgery (TORS) to try to de-intensify the treatment burden among the OPSCC patient population. TORS involves using robotic technology to safely remove tumors from the tongue and tonsil through the mouth. Oncologic and functional outcomes have proven to be excellent, and one of the goals of the division is to allow patients to resume an oral diet the day after surgery without the need for a feeding tube.
The Division of Head and Neck Surgery developed its own protocol in conjunction with Speech and Language Pathology that has led to a significantly lower rate of feeding tube placement compared to other centers that can range up to 48 percent2-3.
Between 2018 and 2021, Mass Eye and Ear head and neck surgeons studied 184 TORS procedures for the treatment of OPSCC. Over that time span, only 7.1 percent of patients required a feeding tube at any point during their treatment, including during radiation. Notably, the rate of peri-operative feeding tube requirement was approximately half that, with only 3.3 percent of patients requiring a temporary nasogastric feeding tube within 30 days after TORS, a rate lower than any published in literature thus far1.
Feeding tube percentage for patients undergoing transoral robotic surgery for oropharyngeal squamous cell carcinoma
- Feng AL, Holcomb AJ, Abt NB, Mokhtari TE, Suresh K, McHugh CI, Parikh AS, Holman A, Kammer RE, Goldsmith TA, Faden DL, Deschler DG, Varvares MA, Lin DT, Richmon JD. Feeding Tube Placement Following Transoral Robotic Surgery for Oropharyngeal Squamous Cell Carcinoma. Otolaryngol Head Neck Surg. 2021 Jun 22. PMID: 34154449.
- Al-Khudari S, Bendix S, Lindholm J, Simmerman E, Hall F, Ghanem T. Gastrostomy tube use after transoral robotic surgery for oropharyngeal cancer. ISRN Otolaryngol. 2013; 2013: 190364.
- Plonowska KA, Ochoa E, Zebolsky AL, et al. Nasogastric tube feeding after transoral robotic surgery for oropharynx carcinoma. Am J Otolaryngol. 2021;42: 102857.