Postoperative Functional Status of the Elderly after Transoral Robotic Surgery

Presentation: AHNS-032
Topic: Mucosal - HPV Positive
Type: Oral
Date: Wednesday, May 1, 2019
Session: 4:05 PM - 5:00 PM Scientific Session 4 - HPV Positive
Authors: Meghan B Crawley, MD, MS, Michael C Topf, MD, Kealan Hobelmann, MD, Adam Luginbuhl, MD, Joseph M Curry, MD, David M Cognetti, MD
Institution(s): Thomas Jefferson University Hospital

IMPORTANCE: The use of transoral robotic surgery (TORS) in patients >70 is not uncommon but there is a paucity of data regarding functional status of these patients following surgery.

OBJECTIVE: To determine if patients >70 years old had significant post-operative differences in functional status compared to younger patients following primary TORS.

DESIGN: Retrospective cohort study

SETTING: Single tertiary academic center

PARTICIPANTS: Retrospective cohort study of patients that underwent TORS for resection of squamous cell carcinoma from February 2011 through July 2016. 341 patients were identified from a database of patients who underwent TORS. Patients were excluded from analysis if the surgical indication was not for resection of squamous cell carcinoma. 267 patients were included in the analysis.  

EXPOSURES: Transoral robotic surgery

MAIN OUTCOMES AND MEASURES: Data collected included demographics, tumor characteristics, and cancer staging. Functional status was evaluated with diet and enteral feeding status. A validated swallowing scale, Functional Oral Intake Scale (FOIS) was calculated to quantify swallowing function. These findings were analyzed by age and malignancy status.

RESULTS: The average age of the entire cohort of 267 patients was 63.5 [SD: 9.7] years. There were 72 patients that were older than 70 years (mean [SD] age 75.9 [5.3] years).  29.6% of the patients greater than 70 years were female compared to 15.9% in patients <70 years (P=0.039). There were no significant differences with respect to tumor (p=0.521), node (P=0.406), or metastasis stages (P=0.636). The number of patients that had P16 positive tumors was 69% in the >70 years cohort versus 83.6% (P=0.011). Length of stay was 3.49 days for patients >70 relative to 2.69 days for younger patients (t-test 2-tailed P=0.034). There was no difference in readmission rates between the two cohorts. 43.7% of patients > 70 years were discharged with enteral access versus 21% (P=0.001). At 1 year follow up there was no significant difference in patients that were still using a gastrostomy tube between age groups (7% versus 5.1%) (P=0.386). There was no significant difference in FOIS score at 1 year follow up between the two groups, 6 in elderly patients versus 6.15 (P=0.436).

CONCLUSIONS: Transoral robotic surgery is safe in patients greater than 70 years old, they have slightly increased length of stay, are more likely require perioperative enteral feeding, but are not more likely to be readmitted. At 1 year, there are similar outcomes across age groups with respect to swallowing function.