Characterizing postoperative physiologic swallow function following transoral robotic surgery for early stage tonsil, base of tongue, and unknown primary human papillomavirus-associated squamous cell carcinoma

• Authors: Lauren Ottenstein, Emory University; Hannah Cornett, Emory University; Jeffrey Switchenko, Emory University; Meghana Nathan, Emory University; Susan Thomas, Emory University; Amanda Gillespie, Emory University; Nancy McColloch, Emory University; Tiffany Barrett, Winship Cancer Institute, Atlanta; Matthew B Studer, Emory University; Meghan Brinkman, Emory University; Azeem Kaka, Emory University; Brian Boyce, Emory University; Robert L Ferris, University of Pittsburgh; Ashley Aiken, Emory University; Mark El-Deiry, Emory University; Jonathan Beitler, Emory University; Mihir Patel, Emory University
• Journal Title: HEAD AND NECK-JOURNAL FOR THE SCIENCES AND SPECIALTIES OF THE HEAD AND NECK
• Volume: Volume 43, Number 5
• Publisher: WILEY | 2021-02-05, Pages 1629-1640
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1002/hed.26632
• Subjects: Health Sciences, Medicine and Surgery; Health Sciences, Radiology
• Keywords: Science & Technology; Life Sciences & Biomedicine; Otorhinolaryngology; Surgery; dysphagia; HPV; Modified Barium Swallow; oropharyngeal cancer; TORS

Abstract

Background: Data objectively evaluating acute post-transoral robotic surgery (TORS) swallow function are limited. Our goal was to characterize and identify clinical variables that may impact swallow function components 3 weeks post-TORS. Methods: Retrospective cohort study. Pre/postoperative use of the Modified Barium Swallow Impairment Profile (MBSImP) and Penetration-Aspiration Scale (PAS) was completed on 125 of 139 TORS patients (2016–2019) with human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma. Dynamic Imaging Grade of Swallowing Toxicity (DIGEST) scores were retrospectively calculated. Uni/multivariate analysis was performed. Results: Dysfunctional pre-TORS DIGEST scores were predictive of post-TORS dysphagia (p = 0.015). Pre-TORS MBSImP deficits in pharyngeal stripping wave, swallow initiation, and clearing pharyngeal residue correlated with airway invasion post-TORS based on PAS scores (p = 0.012, 0.027, 0.048, respectively). Multivariate analysis of DIGEST safety scores declined with older age (p = 0.044). Odds ratios (ORs) for objective swallow function components after TORS were better for unknown primary and tonsil primaries compared to base of tongue (BOT) (OR 0.35–0.91). Conclusions: Preoperative impairments in specific MBSImP components, older patients, and BOT primaries may predict more extensive recovery in swallow function after TORS.