Dysphagia profiles after primary transoral robotic surgery or radiation for oropharyngeal cancer: A registry analysis.

OBJECTIVE To describe the physiologic swallowing impairments (MBSImP™©) associated with safety/efficiency impairments (DIGESTsafety /DIGESTefficiency grades) at 3-6 months after transoral robotic surgery (TORS) or radiation therapy (RT). STUDY DESIGN Secondary analysis of registry data. SETTING Single, academic institution. METHODS Two hundred and fifty-seven patients with HPV+ oropharynx cancer were stratified by primary treatment (75 TORS, 182 RT). Modified barium swallow studies were analyzed at baseline and 3-6 months using MBSImP scores and DIGESTsafety /DIGESTefficiency grades. DIGESTsafety /DIGESTefficiency grades and MBSImP were compared groupwise and associations between DIGESTsafety /DIGESTefficiency grades and MBSImP were explored by ordinal logistic regression. Exploratory analyses were stratified by multimodality treatment. RESULTS Neither DIGESTsafety /DIGESTefficiency differed significantly between groups at baseline or 3-6 months. Laryngeal vestibule closure was impaired more frequently in the RT group (RT: 41% vs. TORS: 27%; p = 0.02) while the TORS group had significantly more pharyngeal contraction impairment (63%; p < 0.001) compared to RT at 3-6 months. CONCLUSION The results suggest a focal injury associated with DIGESTsafety /DIGESTefficiency post-TORS in contrast to a low-level diffuse physiologic impairment associated with post-RT dysphagia.