J Korean Dysphagia Soc.  2020 Jan;10(1):79-91. 10.34160/jkds.2020.10.1.010.

Risk Factor Analysis of Dysphagia after Oncological Surgery for Patients with Head and Neck Cancer Using a Modified Barium Swallowing Study

Affiliations
  • 1Department of Otorhinolaryngology-Head and Neck Surgery, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
  • 2Department of Otorhinolaryngology-Head and Neck Surgery, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,

Abstract


Objective
This study evaluated the risk factors for tube feeding dependency of the patients with head and neck squamous cell carcinoma (HNSCC) who underwent an operation with curative intent.
Methods
The medical records of patients with HNSCC who underwent operation with curative intent and who also had postoperative MBSS (modified barium swallow study) performed at a single institution were retrospectively reviewed between January 2013 and December 2018. The clinical and oncological characteristics along with the MBS findings and questionnaire results were retrieved. These were used to analyze the potential risk factors for tube feeding dependency after surgery. Univariate analysis of each factor was conducted and the odds ratios were calculated. Additionally, multivariate analysis was performed for the significant factors found on the univariate analysis.
Results
60 HNSCC patients (male:female=54:6) with four different primary sites of cancer and who had a mean age of 65.90±11.09 years-old were included in this study. 41 (68.3%) patients were T1-T2, 33 (55%) patients were N+, and 36 (60%) patients were advanced staged (III and IV). 30 (50%) patients received reconstruction with various flaps and 55 (91.7%) patients received neck dissection. Univariate analysis showed a prior history of radiation based therapy and chemoradiation along with silent aspiration, aspiration, pyriform sinus residue, pharyngeal weakness, and high PAS and SPS scores based on MBS showed a significant risk for feeding tube dependency. Multivariate analysis using these factors showed that only the prior history of radiation based therapy and a high SPS score were significant risk factors for feeding tube dependency.
Conclusion
Our study showed a 21.7% rate of feeding tube dependency after surgical treatment of HNSCC. A prior history of radiation based treatment and a higher swallowing performance scale score were the significant risk factors for tube feeding dependency.

Keyword

Head and neck cancer; Surgery; Dysphagia; Risk factor; Modified barium swallow study
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