Early Identification of Gastrostomy Tube Placement in the Surgical Treatment of Head and Neck Cancer

BACKGROUND: There is no consensus on optimal timing or indications for gastrostomy tube (G-tube) placement for Head and Neck Cancer (HNC) patients. While avoiding procedural risks for many, a reactive-only approach has been linked to longer hospital stays, higher costs, and complications related to prolonged hospitalization for some patients. The aim of this study was to identify patients at risk of gastrostomy during the primary hospitalization. METHODS: Retrospective review of patients who underwent HNC resection and reconstruction at a single academic institution (2017-2022) was completed. Statistical analysis was performed with Stata. RESULTS: Across 145 patients, tumor site [55% oral, 6% oropharynx, 7% hypopharynx, 31% larynx] significantly influenced G-tube placement (p < 0.0005). The following were independently associated with reactive G-tube placement: sex (females, HR 1.81, 95% CI 1.01-3.23), tumor site (oropharynx 2.42, 95% 1.29-4.54; larynx 0.16, 95% 0.07-0.36), and prior systemic therapy (0.22, 95% 0.05-0.96); which were used to create a nomogram for patient counseling. CONCLUSIONS: Presurgical risk stratification offers a value-based approach for identifying HNC patients most likely to require G-tube placement.