Postoperative Dysphagieprävalenz bei Kopf-Hals-Tumorpatienten im akutstationären Setting

Zusammenfassung

Hintergrund Dysphagie bildet eine häufige postoperative Funktionsbeeinträchtigung bei Kopf-Hals-Tumorpatienten. Diese kann in Aspiration bzw. Penetration sowie Oralisierungseinschränkung resultieren und ist dadurch häufig versorgungsrelevant. In dieser Studie wurden die Prävalenz einer postoperativen Dysphagie und der Zusammenhang zwischen Ausprägungsgrad und Tumorstadium, Tumorlokalisation, Patientenalter und -geschlecht im akutstationären Setting untersucht.

Material und Methoden Prospektiv wurden 201 erwachsene Kopf-Hals-Tumorpatienten (Altersdurchschnitt 63 Jahre) in 2 Universitätskliniken hinsichtlich Penetration/Aspiration, Oralisierungseinschränkung und Versorgungsrelevanz direkt nach der operativen Tumorbehandlung via FEES untersucht. In uni- und multivariaten Berechnungen wurde zudem der Einfluss der o. g. Patientenmerkmale auf diese 3 Parameter analysiert.

Ergebnisse Eine versorgungsrelevante Schluckstörung bestand bei 66,7 % (134/201) der Patienten. 57,2 % der Patienten benötigten eine Nasogastral- oder PEG-Sonde bei therapierelevanter Oralisierungseinschränkung, weitere 45,3 % aspirierten, 38,5 % von diesen still. Als signifikante Einflussfaktoren erwiesen sich ein höheres Tumorstadium und Patientenalter sowie männliches Geschlecht, die Tumorlokalisation dagegen nur marginal.

Schlussfolgerungen Die Studienergebnisse demonstrieren die klinische Bedeutung und die Notwendigkeit der konsequenten und systematischen Versorgung postoperativer Schluckstörungen bei Kopf-Hals-Tumorpatienten im akutstationären Aufenthalt zur Komplettierung moderner onkologischer Therapie.

Abstract

Objective Dysphagia constitutes a frequent post-operative functional impairment in head-and-neck cancer patients. This impairment can result in aspiration/penetration and limitations of oral intake. Therefore, often it requires a therapeutic intervention. In this study, prevalence of post-operative dysphagia and its associations with the tumour stage, localisation, patients’ age, and biological sex were analysed for the inpatient treatment setting.

Material and Methods A total of 201 adult head-and-neck cancer patients (mean age 63 years) were analysed prospectively by FEES in two university hospitals in regard to their penetration/aspiration, limitations of oral intake, and need for therapeutic interventions directly after the operative tumour treatment. Additionally, the influence of the same patients’ characteristics on these three parameters were analysed by means of univariate and multivariate statistical methods.

Results Out of 201 patients, 66.7 % needed a therapeutic intervention because of their dysphagia, 57.2 % needed a nasogastral or PEG tube due to limitations of oral intake, 45.3 % had an aspiration. In the latter subgroup, 38.5 % had a silent aspiration. Higher tumour stage, patients’ higher age and male sex were shown to be significant influence factors for dysphagia, tumour localisation showed only a marginally significant result.

Conclusions The study demonstrated a clinical importance and relevance of the consequent and systematic treatment of post-operative dysphagia in head-and-neck cancer patients in the acute care units as a constituent of a modern oncological therapy.

Schlüsselwörter

Kopf-Hals-Tumor - Dysphagie - Aspiration - Penetration - PEG

Key words

head-and-neck cancer - dysphagia - aspiration - penetration - PEG

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