Functional Outcomes after Subtotal/Total Glossectomy with Microsurgical Reconstruction: A Multicenter Prospective Observational Study in Japan.

Background: This prospective observational multicenter study aimed to provide evidence-based data on the risk factors for feeding tube dependence, oral intake level, and speech function after tongue reconstruction.

Patients And Methods: This study was conducted by the Oral Pharyngeal Esophageal Operation and Reconstruction Analytical group across 21 Japanese institutions. Patients with oral tongue squamous cell carcinoma who underwent microsurgical reconstruction following subtotal/total glossectomy were included. Functional evaluations were performed 1 year postoperatively. The primary endpoint was postoperative feeding tube dependence. The other outcome variables were oral intake level and speech function at the time of evaluation.

Results: Overall, 189 patients were enrolled, of whom 121 (64.0%) were followed up for 1 year after surgery and were eligible for the final analysis. The overall rate of feeding tube dependence was 12.4% (n = 15) at the primary endpoint. Univariate analysis revealed that tongue defect type, laryngeal suspension, and postoperative chemotherapy were associated with feeding tube dependence. The oral intake level was affected by age at surgery, laryngeal suspension, and postoperative chemoradiation. Speech function was affected by age at surgery, American Society of Anesthesiologists physical status (class 2), medical comorbidities of hypertension and cardiac dysrhythmia, primary tumor stage (T4), neck dissection, reconstructive procedure, laryngeal suspension, and postoperative radiation.

Conclusions: This study provides useful data for estimating individual risk factors associated with feeding tube dependence, oral intake level, and speech function before tongue reconstruction. These results can help surgeons and patients make informed decisions and optimize the functional outcomes of tongue reconstruction.