Patients undergoing transoral robotic surgery for head and neck cancer may experience improvements in some outcomes when given an extended course of corticosteroids, finds a randomized controlled trial reported at the 9th International Conference on Head and Neck Cancer.1
Relative to peers given only a single intraoperative dose of dexamethasone, patients in whom the drug was extended for several days had pain ratings that were about 2 points lower on the third postoperative day, although other measures of pain did not differ. Also, those who received an extended course of corticosteroids were able to go home 1 day earlier and were able to eat a more normal diet during their recovery.
It [extended corticosteroids] does decrease postoperative length of stay, may provide a modest decrease in postoperative pain, and may slightly accelerate advancement of diet consistency.— Daniel R. Clayburgh, MD, PhD
“This was not an overwhelmingly positive study, but there are potentially some benefits to extended corticosteroids after [transoral robotic surgery],” summarized first author Daniel R. Clayburgh, MD, PhD, an otolaryngologist at the Oregon Health and Science University in Portland.
“It is well tolerated by patients, particularly if you screen out the patients who are diabetic or will potentially have problems with hyperglycemia,” he elaborated. “It does decrease postoperative length of stay, may provide a modest decrease in postoperative pain (although a pretty small difference), and may slightly accelerate advancement of diet consistency.”
The investigators studied 76 nondiabetic patients with T1–T2 oropharyngeal cancer who had a planned transoral robotic surgery resection. Surgery included both base of the tongue resection and radical tonsillectomy, with concurrent neck dissection, according to Dr. Clayburgh.
All patients received corticosteroids (10 mg of dexamethasone) during surgery. They were then treated on a double-blind basis with either placebo or more corticosteroids (8 mg of dexamethasone 3 times daily) until hospital discharge, up to a maximum of 4 postoperative days.
“There is really good evidence in the literature, including a Cochrane review, that supports the use of a single intraoperative dose of corticosteroids for posttonsillectomy pain control,” Dr. Clayburgh said, explaining part of the rationale. “But transoral robotic surgery is not equivalent to tonsillectomy—it’s more extensive.”
Pain and Length of Hospital Stay
Patient-rated pain on a 10-point visual analog scale did not differ between groups on postoperative day 1 or 2. But on postoperative day 3, the rating was lower in the corticosteroid group than in the placebo group (~5 points vs ~7 points, P = .004). The groups were statistically indistinguishable with respect to pain ratings on postoperative days 7 through 21, the amount of opioid pain medication received, and pain scores assessed with the University of Michigan quality-of-life tool.
The median length of hospital stay was shorter in the corticosteroid group, at 4 days, than in the placebo group, at 5 days (P < .001). However, the groups had essentially the same total number of complications and numbers of specific complications.
Quality of Life
The corticosteroid group appeared to have less dysphagia during recovery, as assessed with the 100-point diet scale of the Performance Status Scale for Head and Neck Cancer Patients. Scores for postoperative days 7 through 21 averaged 52 points (roughly corresponding to soft chewable foods) in the corticosteroid group and 37 points (roughly corresponding to soft foods requiring no chewing and pureed foods) in the placebo group (P = .009).
There was no difference between the groups in terms of the amount of weight lost, number of days with a feeding tube, and swallowing function, as assessed with either the Eating Assessment Tool (EAT-10) or the University of Michigan quality-of-life tool. ■
Disclosure: Dr. Clayburgh reported no potential conflicts of interest.
1. Clayburgh D, Stott W, Bolognone R, et al: A randomized, double-blind, placebo-controlled trial of extended course corticosteroid for positive-operative pain control following transoral robotic surgery. 2016 International Conference on Head and Neck Cancer. Abstract S062. Presented July 17, 2016.
Michael L. Hinni, MD
“Endoscopic transoral surgeons have used corticosteroids for years before, during, and after transoral operations to prevent presumptive airway edema and to reduce the risks of tracheostomy,” commented one of the session co-moderators, Michael L. Hinni, MD, Chair of...!-->!-->