Sarcopenia is associated with poor swallowing outcomes after resection and free flap reconstruction for oral cancer

Objectives To assess the relationship between radiographically identified sarcopenia and posttreatment swallowing function in patients undergoing primary resection and free flap reconstruction for squamous cell carcinoma of the oral cavity. Materials and Methods Skeletal muscle area was measured at the C3 level using computed-tomography scans of the head and neck in 54 patients with squamous cell carcinoma of the oral cavity. Sarcopenia was assessed using sex-specific cutoffs for skeletal muscle index. Posttreatment swallowing outcomes were assessed using the Functional Oral Intake Score. Results Skeletal muscle index was negatively correlated with age-at-surgery (p = 0.0231). Preoperative sarcopenia was present in 44.4% (24/54) of patients. Patients with normal swallowing function had significantly higher skeletal muscle indices before surgery, compared to patients with swallowing impairment (p = 0.0245). In patients younger than 65 years old, skeletal muscle indices were significantly less in those that required tube feeds at their 6-month postoperative swallowing evaluation, compared to those who did not (p = 0.0241). Sarcopenia status was not associated with functional differences in gastrostomy tube requirement, tracheostomy requirement, time before oral intake, or survival with mean follow-up of 31.7 months. Conclusion Skeletal muscle status may have a prognostic and functional impact on patients with oral cavity squamous cell carcinoma. Pretreatment skeletal muscle index is associated with swallowing function at the time of evaluation and with feeding tube reliance after surgery on univariate analysis. Future assessments of sarcopenia should incorporate functional assessments in addition to radiographic assessments for better prognostic utility.