Swallowing Function and Perioperative Complications After Transoral Robotic Surgery

Area of Science:

• Otolaryngology
• Robotic Surgery
• Swallowing Disorders

Background:

• Transoral robotic surgery (TORS) offers excellent oncologic outcomes for oropharyngeal squamous cell carcinoma (OPSCC).
• Early swallow rehabilitation outcomes following TORS require further investigation.

Purpose of the Study:

• To evaluate perioperative swallow physiology and patient-perceived swallow function after TORS for OPSCC.
• To assess the impact of TORS on swallowing function and patient experience.

Main Methods:

• Retrospective cohort study of 212 adult OPSCC patients undergoing TORS (2017-2024).
• Videofluoroscopic swallow studies (VFSS) and MD Anderson Dysphagia Inventory (MDADI) questionnaires were used for assessment.
• Swallow function was evaluated using the Dynamic Image Grade of Swallowing Toxicity (DIGEST) score.

Main Results:

• Most patients (97.6%) had normal baseline VFSS. On postoperative day 1, 95.8% were evaluated by speech-language pathologists (SLP).
• At discharge, 97.6% tolerated oral diets; only 6.6% required enteral feeding tubes.
• At 6 weeks, 63.6% reported worsened swallowing perception (MDADI), but only 9.1% showed objective decline (VFSS). 95.3% consumed soft to regular diets.

Conclusions:

• TORS for OPSCC is associated with excellent short-term swallowing outcomes.
• Despite subjective worsening in swallow perception for some, objective swallow function remains largely preserved.
• Most patients can tolerate a modified or regular diet within 6 weeks post-surgery.