Preoperative risk assessment for gastrostomy tube placement in head and neck cancer patients

The presentation and definitive surgical treatment of head and neck malignancies have varying impact on postoperative recovery and return of swallowing function, which heretofore has not been well defined.

We performed a retrospective chart review of 142 patients who underwent extirpative surgery for head and neck cancer.

Factors significantly associated with the need for long-term postoperative nutritional support (p < .05) included heavy alcohol use, tongue base involvement and surgery, pharyngectomy, composite resection, reconstruction with a myocutaneous flap, radiation therapy, tumor size, and moderately-to-poorly differentiated histology. Heavy alcohol users were at an absolute risk for gastrostomy tube dependence; patients who underwent radiation therapy, flap reconstruction, tongue base resection, and pharyngectomy were at a two to sevenfold increased risk for gastrostomy tube dependence, respectively.

High-risk patients based on these criteria should receive a feeding gastrostomy at the time of their initial surgical therapy.