(400) Preoperative Risks for Nasogastric Tube Failure Following Oral Cancer Resection

Introduction: Short-term nasogastric tubes (NGT) and long-term percutaneous endoscopic gastrostomy (PEG) tubes are commonly used methods for delivering enteral nutrition following oral cavity cancer (OCC) resection, but selection of enteral tube feeding method is currently left to surgeon preference due to a lack of established guidelines for such patients. Proper consideration of risk factors for NGT feeding failure could optimize patient outcomes.

Methods: In this case control study, we investigated pre-operative risk factors for NGT failure. We performed a retrospective analysis on electronic records of 81 patients seen between 2014 and 2022 who received NGT feeding following OCC resection at an NCI-designated Comprehensive Cancer Center. Comparisons were made between patients who successfully completed NGT (NGT Only) and patients who received a PEG-tube after failing NGT (NGT+PEG). Various statistical analyses were carried out in SPSS v28 with a p value cutoff of p< 0.05.

Results: We report on patient demographics and pre-operative medical history and cancer factors that can be used to optimize enteral nutrition planning following OCC resection. We observed that long-term absence of smoking behavior was a significant predictor of NGT success (p < 0.05). Comprehensive analysis of medical history revealed that hypothyroidism and mood disorders were associated with higher rates of NGT failure (p < 0.05). The presence of eating difficulties prior to surgery not related to dysphagia predicted NGT failure while other reported HEENT symptoms did not (p < 0.05). Patients with lower clinical T-stage (T1 and T2), N stage, and overall clinical stage were more likely to successfully move to PO feeding from NGT (p < 0.05).

Conclusions: Our study shows that pre-operative medical history and clinical cancer staging can be used to help determine patient risk of NGT failure and optimize enteral nutrition planning after OCC resection. Future studies will compare clinical outcomes between NGT and PEG patients and seek to establish a metric for quantifying patient risk.