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
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Article info
Publication history
Published online: August 22, 2022
Accepted:
August 17,
2022
Received:
May 13,
2022
Footnotes
☆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.
