두경부암 환자들에서 근치적 목적의 수술 후 발생하는 연하곤란증의 변형된 바륨 삼킴검사를 활용한 위험인자 분석

초록

Objective: This study evaluated the risk factors for tube feeding dependency of the patients with head and necksquamous cell carcinoma (HNSCC) who underwent an operation with curative intent. Methods: The medical records of patients with HNSCC who underwent operation with curative intent and who alsohad postoperative MBSS (modified barium swallow study) performed at a single institution were retrospectively reviewedbetween January 2013 and December 2018. The clinical and oncological characteristics along with the MBSfindings and questionnaire results were retrieved. These were used to analyze the potential risk factors for tubefeeding dependency after surgery. Univariate analysis of each factor was conducted and the odds ratios were calculated. Additionally, multivariate analysis was performed for the significant factors found on the univariate analysis. Results: 60 HNSCC patients (male:female=54:6) with four different primary sites of cancer and who had a mean ageof 65.90±11.09 years-old were included in this study. 41 (68.3%) patients were T1-T2, 33 (55%) patients were N+,and 36 (60%) patients were advanced staged (III and IV). 30 (50%) patients received reconstruction with variousflaps and 55 (91.7%) patients received neck dissection. Univariate analysis showed a prior history of radiation basedtherapy and chemoradiation along with silent aspiration, aspiration, pyriform sinus residue, pharyngeal weakness,and high PAS and SPS scores based on MBS showed a significant risk for feeding tube dependency. Multivariateanalysis using these factors showed that only the prior history of radiation based therapy and a high SPS score weresignificant risk factors for feeding tube dependency. Conclusion: Our study showed a 21.7% rate of feeding tube dependency after surgical treatment of HNSCC. A prior historyof radiation based treatment and a higher swallowing performance scale score were the significant risk factorsfor tube feeding dependency.

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