Is There an Over-Indication for Elective Tracheostomy in Patients With Oral Cavity Cancer?

Area of Science:

• Otolaryngology
• Head and Neck Surgery
• Surgical Oncology

Background:

• Temporary tracheostomies (TT) are frequently employed in oral oncologic surgery to ensure postoperative airway patency.
• The necessity and appropriateness of elective TT in this patient population warrant investigation.

Purpose of the Study:

• To evaluate the rate of over-indication for elective TT in patients undergoing oral and oropharyngeal cancer surgery.
• To identify specific patient and tumor characteristics that may predict the avoidance of TT.

Main Methods:

• A retrospective analysis of 116 patients with oral and oropharyngeal squamous cell carcinoma who underwent resection and TT.
• Application of the Cameron and TRACHY tracheostomy scoring systems to retrospectively assess TT recommendations.
• Collection of demographic, comorbidity, and complication data, alongside tumor anatomy and reconstruction details.

Main Results:

• The Cameron and TRACHY scoring systems agreed with the TT recommendation in only 54.3% and 45.7% of cases, respectively, suggesting potential over-indication.
• Tumor anatomy, reconstruction type, location (mandibular alveolus, anterior tongue), and T and N stages (T1/T2, N0/N1) were associated with shorter decannulation times.
• Patients identified as not needing TT by both scoring systems, with favorable tumor characteristics, experienced shorter decannulation durations.

Conclusions:

• Evidence suggests an over-indication for elective TT in oral cavity and oropharyngeal cancer patients.
• Patients with lateral tumor anatomy, without flap or with fasciocutaneous flap reconstruction, anterior tumor locations, and early-stage disease (T1/T2, N0/N1) may be candidates for avoiding elective TT.