OBJECTIVES: Transoral robotic surgery is a minimally invasive technique used in the management of head and neck cancer, though post-operative odynophagia can be a significant issue. There is debate about the necessity of elective nasogastric tube placement during the peri-operative period. This study examines the proportion of patients requiring elective nasogastric tube placement and evaluates whether pre-operative factors predict the need for nasogastric tube feeding. METHODS: Data from patients who underwent transoral robotic surgery in Oxford were analysed to assess correlations between pre-operative factors and nasogastric tube feeding. RESULTS: Fifty-three patients undergoing transoral robotic surgery underwent elective nasogastric tube placement; 43 per cent required the nasogastric tube for feeding or medication. Multivariate analysis showed significant associations between nasogastric tube feeding and sex (p = 0.028), peri-neural invasion (p = 0.024), tumour size (p = 0.012) and concurrent neck dissection (p = 0.019). CONCLUSION: Although nearly half of the patients benefited from elective nasogastric tube placement, the remainder did not. Benefits and risks of elective nasogastric tube placement should be carefully considered.