Consideration of factors associated with decreased swallowing function in long-term observation after endoscopic resection for superficial head and neck cancer

Aims [Background&Objective] In the treatment of superficial head and neck cancer, it is essential to consider not only curability but also postoperative function. Transoral surgery (TOS) is minimally invasive and has been reported to have excellent outcomes. In our hospital, endoscopic resection (ER), transoral videolaryngoscopic surgery (TOVS), and transoral robotic surgery (TORS) are performed depending on the patient's condition. However, there are few reports of long-term observation of the association between ER and post-treatment decreasing of swallowing function, which can be a problem after treatment. The aim of this study was to retrospectively consider factors associated with decreased swallowing function during long-term observation after ER.

Methods [Subjects and Methods] The study included 216 cases of superficial head and neck cancer treated with ER in our hospital from January 2020 to October 2024. We excluded cases that underwent TOS for metachronous lesions during this period and cases in which the final pathology diagnosis was other than SCC. We collected data from medical records, including age, sex, performance status (PS), BMI, smoking history, alcohol history, treatment history, radiation history, and albumin level at the time of treatment. Additional data included the number of simultaneous resections, resection site, resection area, presence of muscle layer injury or tracheostomy, lesion size, T classification, and macroscopic type. Swallowing function was evaluated using the Functional Outcome Swallowing Scale (FOSS) two years after treatment. Cases with unchanged FOSS scores were classified as the preserved function group, while cases with increased FOSS were classified as the decreased function group.

Results [Results] Among the 155 cases analyzed, 139 (89.6%) were in the preserved function group, and 16 (10.3%) were in the decreased function group. Univariate analysis showed a significant association between decreased swallowing function and a history of head and neck radiation (7.9% vs. 31.3%, p=0.013) as well as tracheostomy (9.4% vs. 31.3%, p=0.023). Logistic regression analysis including age and sex identified head and neck radiation history as an independent factor (p=0.028).

Conclusions [Conclusion] A history of head and neck radiation was an independent factor associated with decreased swallowing function in long-term observation ER for superficial head and neck cancer. This result is an important factor to be considered in preserving postoperative swallowing function.

Publication History

Article published online:
27 March 2025