title: Swallowing function and tracheotomy dependence after combined-modality treatment including free tissue transfer for advanced-stage oropharyngeal cancer.
abstract: OBJECTIVE
  There are many treatments available for advanced oropharyngeal cancer. Organ-sparing protocols reserve surgery for salvage and are thought to provide adequate rehabilitation. Surgical resection with free tissue transfer may also provide adequate functional rehabilitation. The objective was to describe swallowing status and time to decannulation in a series of patients treated with combined-modality therapy that included free flap reconstruction.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  Patient data were obtained from medical records of 20 patients with stage III or IV oropharyngeal carcinoma, who were consecutively treated with surgical tumor extirpation, free flap reconstruction, and postoperative irradiation at a tertiary academic center from 1985 to 2002. The following variables were identified: patient and tumor characteristics, free flap type, irradiation data, and airway and swallowing status before and after treatment.
  
  
  RESULTS
  One patient underwent total laryngopharyngectomy, and the remaining 19 patients underwent tracheotomy at the time of definitive surgery. Free flap reconstructions included 1 ulnar and 15 radial forearm fasciocutaneous flaps and 4 fibula osteocutaneous flaps. Postoperatively, all 19 tracheotomized patients had successful decannulation. Average time to decannulation was 15 days (range, 3-42 d). After surgery and before irradiation, 13 patients initiated oral intake, on average, at 19.5 days (range, 7-28 d); 6 patients required no additional supplementation. By 4 months after surgery, having completed radiation therapy, 10 patients were consuming all nutrition orally; the other 10 patients still required tube-feed supplementation, although 6 of these patients were also eating by mouth.
  
  
  CONCLUSIONS
  Combined-modality treatment that includes free flap reconstruction for advanced-stage oropharyngeal cancer may provide reasonable functional rehabilitation with respect to postoperative airway and swallowing.
authors.affiliation: Department of Otolarynology-Head and Neck Surgery, Oregon Health and Science University, Portland, 97239, USA.
authors.forename: Judith M
authors.initials: JM
authors.lastname: Skoner
authors.forename: Peter E
authors.initials: PE
authors.lastname: Andersen
authors.forename: James I
authors.initials: JI
authors.lastname: Cohen
authors.forename: John J
authors.initials: JJ
authors.lastname: Holland
authors.forename: Eric
authors.initials: E
authors.lastname: Hansen
authors.forename: Mark K
authors.initials: MK
authors.lastname: Wax
mesh_terms: D000368:Aged; D003131:Combined Modality Therapy; D003679:Deglutition; D004435:Eating; D004750:Enteral Nutrition; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009959:Oropharyngeal Neoplasms / Q000503:physiopathology / Q000532:radiotherapy / Q000601:surgery*; D011183:Postoperative Complications; D012189:Retrospective Studies; D013524:Surgical Flaps; D014140:Tracheotomy