Rapid Fire Best of the Best Oral 2025 Joint Meeting of the COSA ASM and IPOS Congress

Nutrition and swallowing outcomes following transoral robotic surgery (TORS) +/- adjuvant treatment for head and neck cancer (126628)

Teresa Brown 1 2 , Ryan Sommerville 3 , Tom Slaughter 3 , Juliet Hoey 4 , Jake Ahmed 3 , Elise Treleaven 2 , Clare Burns 4 , Brett Hughes 5 6 , Judy Bauer 7
  1. School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, QLD, Australia
  2. Dietetics and Food Services, Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia
  3. ENT Surgery, Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia
  4. Speech Pathology, Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia
  5. School of Medicine, University of Queensland, Brisbane, Queensland, Australia
  6. Cancer Care Services, Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia
  7. Department of Nutrition, Dietetics and Food, Monash University, Melbourne, VIC, Australia

Objectives/purpose

To investigate the impact of transoral robotic surgery (TORS) in relation to post-operative nutrition and swallowing outcomes.

Sample and setting

A prospective longitudinal cohort study at a tertiary hospital in Brisbane, Australia, from January 2024 to March 2025. Inclusion criteria: adults with untreated oropharyngeal cancer planned for primary TORS and able to give informed consent. Exclusion criteria: TORS for salvage surgery.

Procedures

Outcome data were collected at baseline (pre-operative) and at 2-weeks and 3-months post-operatively. Nutrition outcomes included weight (kg), nutritional status (PG-SGA), and tube feeding status. Swallowing outcomes included diet and fluid status using the International Dysphagia Diet Standardisation (IDDSI) and the MD Anderson Dysphagia Inventory (MDADI).

Results

Nine male patients were recruited (median age 66, range 40-83). Diagnosis was predominantly oropharyngeal scc (T stage 0-3; N stage 0-2). Eight patients had a neck dissection, and five patients had adjuvant (chemo)radiotherapy. Eight patients were well-nourished pre-operatively (SGA A) and one patient had moderate malnutrition (SGA B).

At 2-weeks post-op, two patients were nil by mouth (n=1 gastrostomy; n=1 nasogastric tube), with three patients now malnourished (SGA B). Weight loss varied between 2.1% to 6.5%. Four patients required puree or minced diet and one required thickened fluids. Median Global MDADI score was 2 (range 1-5) - low functioning.

At 3-months post-op, one patient had died of unrelated causes (gastrostomy in situ). Six patients were on regular diet and thin fluids. Two patients required texture modification (soft, puree) and two needed thickened fluids. Median Global MDADI score improved to 4 (range 2-5). Only one patient remained malnourished but requested nasogastric tube removal against advice.

Conclusion and clinical implications

There are significant nutritional and swallowing problems following TORS in the acute perioperative period requiring dietetic and speech pathology input. Routine review of all patients undergoing TORS is recommended until clinically stable.