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CC BY-NC-ND 4.0 · J Reconstr Microsurg Open 2023; 08(01): e1-e11
DOI: 10.1055/s-0043-1760757
Original Article

Predictors of Gastrostomy Tube Placement in Head and Neck Cancer Patients at a Rural Tertiary Care Hospital

Libby R. Copeland-Halperin
1   New York, New York
,
Prashanthi Divakar
2   Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
,
Talia Stewart
3   Department of Surgery, MetroHealth Medical Center, Cleveland, Ohio
,
Falen Demsas
4   Department of Surgery, The Massachusetts General Hospital, Boston, Massachusetts
,
Joshua J. Levy
5   Department of Biomedical Sciences, Geisel School of Medicine, Hanover, New Hampshire
,
John F. Nigriny
6   Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
,
Joseph A. Paydarfar
6   Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
› Author Affiliations Funding Data analysis was performed with the help of statisticians with the support of the Dartmouth Clinical and Translational Science Institute, under award number UL1TR001086 from the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH).
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Abstract

Background Head and neck cancer is a leading cause of cancer. Treatment often requires surgical resection, free-flap reconstruction, radiation, and/or chemotherapy. Tumor burden and pain may limit swallowing and impair nutrition, increasing complications and mortality. Patients commonly require gastrostomy tubes (G-tube), but predicting which patients are in need remains elusive. This study identifies predictors of G-tube among head and neck cancer patients undergoing immediate free-flap reconstruction.

Methods Institutional Review Board approval was obtained. Retrospective database review was performed of patients at 18 years of age or older with head and neck cancer who underwent resection with immediate free-flap reconstruction from 2011 to 2019. Patients who underwent nonfree-flap or delayed reconstruction or with mortality within 7 days postoperatively were excluded. Patient demographics and comorbidities, tumor/treatment characteristics, and need for G-tube were analyzed to identify univariate and multivariate predictors.

Results In total, 107 patients were included and 72 required G-tube placement. On multivariate analysis, tracheostomy (odds ratio [OR]: 81.78; confidence interval [CI]: 7.43–1,399.92; p < 0.01), anterolateral thigh flap reconstruction (OR: 16.18; CI: 1.14–429.66; p = 0.04), and age 65 years or younger (OR: 9.35; CI: 1.47–89.11; p = 0.02) were predictors of G-tube placement.

Conclusion Head and neck cancer treatment commonly involves extensive resection, reconstruction, and/or chemoradiation. These patients are at high risk for malnutrition and need G-tube. Determining who requires a pre- or postoperative G-tube remains a challenge. In this study, the need for tracheostomy or ALT flap reconstruction and age 65 years or younger were predictive of postoperative G-tube placement. Future research will guide a multidisciplinary perioperative pathway to facilitate the optimization of nutrition management.

Keywords

head and neck cancer - gastrostomy tube predictors - delayed reconstruction - free-flap reconstruction - malnutrition - flap-related complications

Note

All authors contributed to this research and development of this manuscript. The content is solely the responsibility of the author(s) and does not necessarily represent the official views of the NIH.




Publication History

Received: 22 February 2022

Accepted: 29 September 2022

Article published online:
10 February 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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