Functional outcomes and tracheostomy dependence following salvage oropharyngeal surgery.

[PURPOSE:] Salvage surgical treatment of oropharyngeal cancer is associated with significant morbidity. We aim to identify predictive factors of functional outcomes to improve patient selection and counseling when contemplating salvage oropharyngectomy.

[METHODS:] Patients with a history of radiation requiring salvage oropharyngeal surgery were identified. Primary outcomes were determined at one year post-salvage surgery and included Gastric tube (G-tube) dependence, dietary restrictions, tracheostomy dependence, and speech intelligibility. Multivariate analyses were performed to identify predictors of the primary outcomes.

[RESULTS:] At one year, 45% (22/49) of patients had a G-tube, 68% (33/48) had dietary restrictions, 10% (5/49) remained tracheostomy dependent, and 15% (4/26) had difficulty with speech intelligibility. On univariate analysis, pre-operative G-tube (83% vs. 40%, p=0.04), reconstruction with a free flap (54% vs. 0%, p=0.005), and bony resection (69% vs. 36%, p=0.04) were significantly associated with G-tube dependence at one year. On multivariate analysis, concurrent bony resection remained a significant predictor of G-tube dependence (HR 5.4, 95% CI 1.2–24, p=0.03). Predictors of dietary restriction included free-flap reconstruction (78% vs. 25%, HR 0.13, 95% CI 0.02–0.87, p=0.04) and recurrence after two years (85% vs. 48%, HR 4.9, 95% CI 1.2–21, p=0.03). Supraglottic laryngectomy was significantly associated with tracheostomy dependence on univariate (67% vs. 7%, p=0.001) and multivariate analysis (HR 44.4, 95% CI 2.0–986, p=0.02).

[CONCLUSION AND RELEVANCE:] Functional outcomes are suboptimal after salvage oropharyngectomy. Specific patient and disease factors are independently associated with worse speech and swallowing outcomes and may aid in pre-operative patient selection, risk stratification, and shared decision-making.