Early Identification of Gastrostomy Tube Candidacy in Patients Undergoing Head and Neck Surgery

Introduction: Maintaining optimal nutritional status presents a challenge for Head and Neck Cancer (HNC) patients due to surgical violation of the aerodigestive tract involvement. There is no consensus on optimal timing or indications for gastrostomy tube (G-tube) placement, and so providers often favor a reactive approach. While avoiding unnecessary risk, a reactive-only approach has been linked to longer hospital stays, higher costs, and complications related to prolonged hospitalization.

Methods: A retrospective review of patients who underwent resection and reconstruction for HNC at a single academic institution from 11/2017 to 10/2022. Statistical analysis and nomogram were completed with Stata and R console.

Results: A total of 145 patients were included [median age at surgery 64 yrs (23-91); 98 males (68%) and 47 females (32%); TNM staging: 2% T1, 12% T2, 16% T3, 36% T4; 41% N0, 8% N1, 19% N2, 9% N3; 89% M0, 3% M1% (AJCC 7th)]. Primary cancer resections were performed in 76% of patients, compared to 24% with recurrent tumors (p=0.6). Tumor sites, [78 (55%) oral, 8 (6%) oropharynx, 10 (7%) hypopharynx, 44 (31%) larynx, 1 (1%) skull base], significantly influenced G-tube placement (p < 0.0005). The following features were independently associated in multivariable analysis with reactive G-tube placement: sex (HR for females, 1.81, 95% CI 1.01-3.23), tumor site (oropharynx HR 2.42, (95% CI 1.29-4.54; larynx HR 0.16, 95% CI 0.07-0.36), and prior systemic therapy (HR 0.22, 95% CI 0.05-0.96); and were used to create a nomogram for patient counseling.

Conclusions: Presurgical risk stratification for HNC patients offers a value-based approach for identifying patients most likely to require supplemental nutrition through G-tube placement.