Please use this identifier to cite or link to this item: http://hdl.handle.net/2440/99575
Type: Theses
Title: Swallowing outcomes following primary surgical resection and primary free flap reconstruction for oral and oropharyngeal squamous cell carcinomas: a systematic review of quantitative evidence
Author: Kao, Stephen Shih-Teng
Issue Date: 2016
School/Discipline: Joanna Briggs Institute
Abstract: Background: Dysphagia is still a treatment related morbidity as organ preservation does not always translate into function preservation despite advances in treatment modalities. The purpose of this systematic review is to review the swallowing outcomes of patients with oral or oropharyngeal squamous cell carcinoma following primary surgery with primary free flap reconstruction with or without adjuvant therapy. Objectives: The objective of this systematic review is to investigate swallowing outcomes following primary surgical resection and free flap reconstruction for the treatment of patients with oral and oropharyngeal squamous cell carcinoma. Dysphagia was evaluated with the use of objective investigations (Videofluoroscopic swallowing studies, Fibreoptic endoscopic evaluations of swallowing, Manometry, Gastrostomy dependency, Tracheostomy dependency) and subjective questionnaires (MD Anderson Dysphagia Inventory, University of Washington Quality of Life Questionnaire, Functional Oral Intake Score). Inclusion criteria: This review considered studies which included patients with oral or oropharyngeal squamous cell carcinoma treated with primary surgical resection and primary surgical reconstruction with or without adjuvant therapy. Swallowing evaluation was conducted at six months or greater after curative therapy. Objective outcome measures included gastrostomy dependency, tracheostomy dependency, penetration-aspiration rates, oral and pharyngeal transit times or pharyngeal pressure readings measured with either videofluoroscopic swallowing studies or fibreoptic endoscopic evaluations of swallowing or manometry. Subjective outcomes were measured with the MD Anderson Dysphagia inventory, University Washington Quality of Life Questionnaire or Functional Oral Intake Scale. Methods: A comprehensive search strategy was undertaken across MEDLINE, CINAHL, Embase, and Scopus. Papers retrieved were assessed by two independent reviewers regarding study design, study population, interventions, outcome measures, results and conclusions for each article. Data extracted and analyzed for descriptive studies and findings presented in narrative form. Results: 15 studies were included in the systematic review, which consisted of eight cohort studies and seven cases series. Postoperative radiotherapy was associated with worse swallowing outcomes. Swallowing outcomes following the use of radial forearm free flap and anterolateral thigh flap were inconclusive. Resections of the oropharynx demonstrated poorer swallowing outcomes compared with oral cavity resections. Conclusion: Radiotherapy has been demonstrated to be detrimental to swallowing function following surgical resection and primary free flap reconstruction. Furthermore, swallowing function was shown to improve with the use of free flap reconstruction compared with primary closure for large tumor resections. From these results, a protocol for the identification of patients at low or high risk of developing dysphagia has been proposed. There is, however, a lack of high quality primary research regarding swallowing outcomes following primary surgery with primary free flap reconstruction for oral and oropharyngeal squamous cell carcinoma.
Advisor: Peters, Micah
Ooi, Eng
Dissertation Note: Thesis (M.Clin.Sc.) -- University of Adelaide, Joanna Briggs Institute, 2016.
Keywords: swallowing
surgical resection
oropharyngeal
squamous
cell carcinomas
Provenance: This electronic version is made publicly available by the University of Adelaide in accordance with its open access policy for student theses. Copyright in this thesis remains with the author. This thesis may incorporate third party material which has been used by the author pursuant to Fair Dealing exceptions. If you are the owner of any included third party copyright material you wish to be removed from this electronic version, please complete the take down form located at: http://www.adelaide.edu.au/legals
Appears in Collections:Research Theses

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