Impact of tongue base mucosectomy on quality-of-life outcomes: systematic review and single-centre experience

Abstract

Purpose: Tongue base mucosectomy (TBM) is a well-established procedure in investigating cervical squamous cell carcinoma of occult primary. However, its risks have not been balanced against its benefits with validated tools.

Methods: A systematic literature review was conducted for reported complications and quality-of-life outcomes following TBM. The complications and quality-of-life outcomes following TBM at our institution are then reported using objective metrics and validated assessment tools, including Performance Status Scale for Head and Neck Cancer Patients (PSS-HNS), University of Washington Quality-of-life Questionnaire (UW-QOL) and M. D. Anderson Dysphagia Inventory (MDADI).

Results: Eighteen studies met the criteria for inclusion in the systematic review. Of these, 9 addressed swallowing outcomes described in text, without using validated assessment tools. No studies reported taste, speech and pain outcomes after TBM. Post-operative bleeding was not consistently reported. 20 patients underwent robotic TBM at our institution between 2017 and 2023. The primary tumour was identified in 50% (10/20) of cases. The median time to commencing soft diet and median time of NG feeding was 0 days. The median return to normalcy of diet score was 95. Median post-treatment UW-QOL pain and swallowing scores were 100 and 70 respectively. The median speech score was 100, saliva 70, and taste 70. The median normalised MDADI scores were: global 80; emotional 67; functional 80 and physical 65.

Conclusions: Validated assessment tools better inform patients about treatment options and can help compare post-TBM results across institutions. Our data demonstrates that TBM patients have a functional post-operative swallow, are pain and gastrostomy free, even after adjuvant treatment. Routine post-operative insertion of NG tube is not necessary.

Keywords: Occult primary; Tongue base mucosectomy; Trans-oral robotic surgery; Unknown primary.

Fig. 1

Robotic tongue base mucosectomy: 2a: shows the view with the landmarks, 2b: shows demarcation of the resection area, 2c: shows orientation and removal of the specimen with the bedside assistant, and 2d: shows the resection bed after removing the specimen

Fig. 2

PRISMA flow diagram of study selection

Fig. 3

Forest plot showing random effects pooled post-operative haemorrhage rate across 15 studies

Fig. 4

Forest plot showing random effects pooled primary site detection rate across 17 studies