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Transoral robotic surgery (TORS) for oropharyngeal squamous cell carcinoma (OPSCC) is now a well-established treatment modality for early (T1-T2) disease. Accumulating evidence suggests that one of its main benefits relative to conventional chemoradiotherapy is superior long-term functional outcome, especially with regards to swallowing. This retrospective cohort study sought to identify how likely gastrostomy tube dependence was following TORS, and risk factors associated with this. Patients treated with TORS for a new diagnosis of OPSCC at a single institution in Philadelphia from January 2011 to July 2016 were recruited for this study. A total of 231 patients were included with a mean age of 63 (range 40-91), 90% of whom had T1-2 disease. Of the tumours, 86% were p16 positive. Mean length of admission following surgery was three days. Of the patients, 37.7% required adjuvant radiotherapy and 43.7% required adjuvant chemoradiotherapy. At three-month follow-up, 25.7% of patients required a gastrostomy tube. Unsurprisingly, adjuvant radiotherapy or chemoradiotherapy were risk factors for gastrotomy tube dependence at this timepoint, along with advanced (T3) stage tumours. By one year, the rate of gastrostomy tube dependence had dropped to 3.9% and, by two years, the rate had dropped further to 2.8%. Advanced T stage and discharge from hospital with enteral access were the only risk factors that remained significantly associated with the ongoing need for a gastrostomy tube at one year. With an overall 97% two-year survival rate, combined with a less than 3% likelihood of requiring a long-term gastrostomy tube, the data from this paper adds further evidence to support the view that TORS is a highly effective treatment for early OPSCC, both from an oncological and functional perspective.

Risk factors for gastrostomy tube dependence in transoral robotic surgery patients.
Philips R, Topf MC, Vimawala S, et al.
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Christopher Burgess

Musgrove Park Hospital, Taunton, UK.

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