Nutritional Outcomes in HPV-Associated Oropharyngeal Squamous Cell Carcinoma After Transoral Robotic Surgery

Nutritional outcomes following transoral robotic surgery (TORS) for human papillomavirus (HPV) associated oropharyngeal squamous cell carcinoma (OPSCC) are poorly understood. This study evaluates how TORS, with or without adjuvant treatment, impacts swallowing and weight loss.

All patients treated with TORS for HPV-associated OPSCC from January 2016 to December 2023 were included. Weight loss, functional oral intake, feeding tube dependence, patient demographics, and treatment course were collected from patients' electronic medical records.

In total, 160 patients with HPV-associated OSPCC treated with TORS were included. 87.5% were male, with a median age of 60.0 years. Most patients were diagnosed with pT1 (53.8%) or pT2 (40.0%) and pN1 (78.1%) disease. 31.9% underwent TORS alone, while 42.5% received adjuvant radiation and 25.6% adjuvant chemoradiation. The median follow-up time was 2.27 (range 0.26-7.56) years. 87.4% of patients underwent nasogastric tube placement during TORS. Prolonged postoperative nasogastric tube dependence was significantly associated with increased rates of feeding tube replacement (p < 0.001; 95% CI, 1.051-1.181) later during treatment. Weight loss from three months to three years postoperatively was significantly greater in patients who received adjuvant radiation and chemoradiation (p < 0.001), despite no significant difference in swallowing outcomes. There was no significant difference in weight loss between adjuvant radiation and chemoradiation groups.

Adjuvant treatment following TORS is associated with significantly greater long-term weight loss but does not significantly alter swallowing outcomes. Longer duration of nasogastric tube dependence in the postoperative period is associated with higher rates of enteral feeding dependence later in treatment.