Evidence map›Paper›PMID 39306590›Full record

ArticleEuropean archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery2025

Phosphate level changes in oral cancer patients - recognizing the risk for refeeding syndrome.

Suvi Silén, Erika Wilkman, Emilia Haukilehto, Arvi Keinänen, Antti Mäkitie, Johanna Snäll

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Article in European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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4 · The record

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5 · Who and what money

Authors and funding

6 authors.

Suvi SilénDepartment of Otorhinolaryngology, Head and Neck Centre, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. suvi.silen@helsinki.fi.ORCID http://orcid.org/0009-0007-4703-1970
Erika WilkmanDepartment of Anaesthesiology and Intensive Care Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Emilia HaukilehtoDepartment of Oral and Maxillofacial Diseases, Clinicum, Faculty of Medicine, University of Helsinki, Helsinki University Hospital, Helsinki, Finland.
Arvi KeinänenDepartment of Oral and Maxillofacial Diseases, Clinicum, Faculty of Medicine, University of Helsinki, Helsinki University Hospital, Helsinki, Finland.
Antti MäkitieDepartment of Otorhinolaryngology, Head and Neck Centre, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Johanna SnällDepartment of Oral and Maxillofacial Diseases, Clinicum, Faculty of Medicine, University of Helsinki, Helsinki University Hospital, Helsinki, Finland.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposePatients with oral squamous cell carcinoma (OSCC) often have difficulties in obtaining sufficient nutrition and may develop refeeding syndrome (RFS) during hospitalization. RFS may be fatal if not treated properly. This study clarified changes in perioperative phosphate levels and occurrence of RFS symptoms in OSCC patients to identify clinically notable predisposing factors for RFS in this specific patient population.

methodsA retrospective analysis included primary OSCC patients with microvascular free flap reconstruction. Patients with treatment for additional malignancy, hypoparathyroidism, and missing values of preoperative and/or postoperative plasma phosphate (P-Pi) concentration were excluded. The outcome variable was severe postoperative hypophosphataemia (mmol/l) during the postoperative period (P-Pi < 0.50 mmol/l). Predictor variables were age, sex, smoking, heavy alcohol use, diabetes, body mass index (BMI), weight, height, tumour site, tumour size, tracheostomy, nutritional route, and preoperative P-Pi concentration.

resultsOf the 189 patients with primary OSCC, 21 (11%) developed severe hypophosphataemia. Of these patients, 17 (81%) developed RFS symptoms. Higher age (p = 0.01), lower patient height (p = 0.05), and no current smoking (p = 0.04) were significantly associated with postoperative hypophosphataemia. In multivariable regression analyses, higher age (OR 1.06 per year) and age over 70 years (OR 3.77) were independently associated with development of severe hypophosphataemia.

conclusionRestoration of nutritional balance and close follow-up of electrolyte balance in the perioperative phase are necessary to prevent RFS, especially in patients with oral cancer requiring extensive reconstructions. Special attention should be focused on elderly patients since they are prone to this unnoticeable but potentially life-threatening electrolyte disturbance.

Indexed as

Carcinoma, Squamous CellHypophosphatemiaMouth NeoplasmsPhosphatesPostoperative ComplicationsRefeeding SyndromeAdultAgedAged, 80 and overFemaleHumansMaleMiddle AgedPlastic Surgery ProceduresRetrospective StudiesRisk FactorsPhosphatesMalnutritionOral cancerOral squamous cell carcinomaRefeeding syndrome

Identifiers

PMID39306590
PMCPMC11805860

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.