ARTICLE SUMMARY
Background
Nutritional status may be impaired in patients with head and neck cancer undergoing
surgical treatment, often necessitating gastrostomy tube (G-tube) placement. Identifying
which patients will require a G-tube remains a challenge. This study identifies predictors
of G-tube requirement in patients undergoing tumor resection and reconstruction with
pedicled or free flaps.
Methods
Systematic review of the PubMed, Cochrane and Scopus databases was performed of English-language
articles discussing risk factors of perioperative G-tube placement among patients
>18 years. Data on patient, tumor, and treatment factors, as well as need for G-tube,
were collected. Univariable meta-analysis was conducted to identify predictors for
G-tube placement.
Results
Eleven studies (1,112 patients) met inclusion criteria. Overall pooled prevalence
of postoperative G-tube placement was 25%. Patients with advanced cancer stage IV/recurrence
were more likely to require a G-tube (OR 2.81 [CI 1.03-7.69]; p<0.05), as were those who had undergone preoperative radiation (OR 3.55 [CI 2.03-6.20],
p<0.05). Reconstruction with a radial forearm free flap was associated with a lower
need for G-tube versus rectus abdominis (OR 0.25 [CI 0.08-0.83], p=0.02), and latissimus dorsi flap (OR 0.21 [CI 0.04-1.09], p=0.06). There was no difference in G-tube placement between those receiving pedicled
flaps versus free flaps (OR 1.54 [CI 0.38-6.20], p=0.54).
Conclusions
Among patients with head and neck cancer undergoing resection with immediate pedicled
or free flap reconstruction, advanced tumor stage and history of prior radiation therapy
are associated with increased likelihood of G-tube placement. More randomized controlled
trials are needed to develop a decision-making algorithm.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Plastic, Reconstructive & Aesthetic SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
REFERENCES
- Head and neck cancers, version 2.2020, NCCN clinical practice guidelines in oncology.J Natl Compr Canc Netw. 2020; 18: 873-898
- Head and neck cancer: Improving outcomes with a multidisciplinary approach.Cancer Manag Res. 2017; 9: 363-371
- Nutritional considerations for head and neck cancer patients: A review of the literature.J Oral Maxillofac Surg. 2013; 71: 1853-1860
- Malnutrition prevalence according to the GLIM criteria in head and neck cancer patients undergoing cancer treatment.Nutrients. 2020; 12: 3493
- Malnutrition and cachexia in patients with head and neck cancer treated with (chemo)radiotherapy.Rep Pract Oncol Radiother. 2015; 20: 249-258
- Gastrostomy tubes in patients with advanced head and neck cancer.Laryngoscope. 2005; 115: 44-47
- Effect of prophylactic percutaneous endoscopic gastrostomy tube on swallowing in advanced head and neck cancer: A randomized controlled study.Head Neck. 2017; 39: 908-915
- Prophylactic percutaneous endoscopic gastrostomy in head and neck cancer patients: Results of tertiary institute.Eur Arch Otorhinolaryngol. 2014; 271: 1755-1758
- Randomised controlled trial of early prophylactic feeding vs standard care in patients with head and neck cancer.Br J Cancer. 2017; 117: 15-24
- The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: Explanation and elaboration.PLoS Med. 2009; 6e1000100
- The PRISMA 2020 statement: An updated guideline for reporting systematic reviews.BMJ. 2021; 372: 1-9
- Rayyan — a web and mobile app for systematic reviews.Syst Rev. 2016; 5: 210
- The newcastle-ottawa scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. 2013; (UpdatedAccessed May 23, 2020)
- Attention should be given to multiplicity issues in systematic reviews.Journal of Clinical Epidemiology. 2008; 61: 857-865
- R and the journal of statistical software.Journal of Statistical Software. 2016; 73: 4967
- Nutrition management for head and neck cancer patients improves clinical outcome and survival.Nutr Res. 2017; 48: 1-8
- Malnutrition in head and neck cancer patients: Impacts and indications of a prophylactic percutaneous endoscopic gastrostomy.Eur Ann Otorhinolaryngol Head Neck Dis. 2019; 136: S27-S33
- Nutritional management in head and neck cancer: United kingdom national multidisciplinary guidelines.J Laryngol Otol. 2016; 130: S32-S40
- Predictive factors for preoperative percutaneous endoscopic gastrostomy placement: Novel screening tools for head and neck reconstruction.J Craniofac Surg. 2015; 26: 2124-2127
- The role of pre-treatment percutaneous endoscopic gastrostomy in facilitating therapy of head and neck cancer and optimizing the body mass index of the obese patient.JPEN J Parenter Enteral Nutr. 2009; 33: 404-410
- Percutaneous endoscopic gastrostomy: Indications, technique, complications and management.World J Gastroenterol. 2014; 20: 7739-7751
- Prospective study of percutaneous endoscopic gastrostomy tubes versus nasogastric tubes for enteral feeding in patients with head and neck cancer undergoing (chemo)radiation.Head Neck. 2009; 31: 867-876
- Patients experience with long-term percutaneous endoscopic gastrostomy feeding following primary surgery for oral and oropharyngeal cancer.Oral Oncol. 2007; 43: 499-507
- Hyperfractionated, accelerated radiotherapy for locally advanced head and neck cancer: Quality of life in a prospective phase I/II trial.RadiotherOncol. 2008; 87: 181-187
- A model for predicting gastrostomy tube placement in patients undergoing surgery for upper aerodigestive tract lesions.JAMA Otolaryngol Head Neck Surg. 2014; 140: 1198-1206
- Risk factors for gastric-tube dependence following tongue reconstruction.Ann Surg Oncol. 2012; 19: 2320-2326
- Prognostic factors for tube feeding dependence after curative (chemo-) radiation in head and neck cancer: A systematic review of literature.Radiother Oncol. 2018; 126: 56-67
- The evolving role of surgery in the management of head and neck tumors.Curr Opin Oncol. 2005; 17: 241-248
- Functional comparison after reconstruction with a radial forearm free flap or a pectoralis major flap for cancer of the tongue.Otolaryngol Head Neck Surg. 2003; 128: 412-418
- Dysphagia after sequential chemoradiation therapy for advanced head and neck cancer.Otolaryngol Head Neck Surg. 2007; 134: 916-922
- Diagnosis and management of oral mucositis.J Support Oncol. 2007; 5: 13-21
- Treatment of mucositis, including new medications.Cancer J. 2007; 12: 348-354
- Videofluoroscopic evaluation after glossectomy.Arch Otolaryngol Head Neck Surg. 2000; 126: 378-383
- Swallowing rehabilitation after oropharyngeal resection for squamous cell carcinoma.Br J Oral Maxillofac Surg. 2000; 38: 513-518
- Swallowing outcomes after microvascular head and neck reconstruction: A prospective review of 191 cases.Laryngoscope. 2007; 117: 1359-1363
- Prediction model for early percutaneous endoscopic gastrostomy (PEG) in head and neck cancer treatment.Oral Oncol. 2012; 48: 355-360
- Swallowing function in patients who underwent hemiglossectomy: Comparison of primary closure and free radial forearm flap reconstruction with videofluoroscopy.Ann Plast Surg. 2003; 50: 450-455
- Comparison of functional outcomes and health-related quality of life one year after treatment in patients with oral and oropharyngeal cancer treated with three different reconstruction methods.Br J Oral Maxillofac Surg. 2020; 58: 759-765
- Pectoralis major myocutaneous flap vs revascularized free tissue transfer: Complications, gastrostomy tube dependence, and hospitalization.Arch Otolaryngol Head Neck Surg. 2004; 130: 181-186
- Functional outcome after one-stage flap reconstruction of the hypopharynx following tumor ablation.Otolaryngol Head Neck Surg. 2017; 274: 969-976
- Functional outcome after total and subtotal glossectomy with free flap reconstruction.Head Neck. 2008; 30: 909-918
- The measurement of comorbidity by cancer registries.J Registry Manage. 2003; 30: 8-14
Article info
Publication history
Accepted:
August 17,
2022
Received:
May 13,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
#Content from this manuscript was presented at the American College of Surgeons, Vermont Chapter Annual Spring Meeting (May 2021). This manuscript, or any content related to this study, has not been previously published.
Identification
Copyright
© 2022 Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons.