Oral feeding after total laryngectomy

Area of Science:

• Otolaryngology
• Surgical Oncology
• Gastroenterology

Background:

• Pharyngocutaneous fistulae complicate 15%-25% of total laryngectomies.
• Preoperative radiation, surgical factors, and tumor characteristics influence fistula risk.
• Delayed oral feeding is a common practice to prevent fistulae.

Purpose of the Study:

• To investigate the association between the timing of postoperative oral feeding and pharyngocutaneous fistula development after total laryngectomy.
• To evaluate current surgical practices regarding postoperative feeding protocols.

Main Methods:

• A survey of 210 American Society for Head and Neck Surgery members assessed feeding practices.
• Retrospective chart review of 137 patients undergoing total laryngectomy for squamous cell carcinoma.
• Analysis of fistula rates based on the timing of oral feeding initiation.

Main Results:

• 84.5% of surgeons surveyed delayed oral feeding until at least postoperative day 7.
• No significant difference in fistula rates was observed between patients fed by postoperative day 5 versus those fed on or after day 6.
• Most fistulae were detected prior to the commencement of oral feeding.

Conclusions:

• Delayed oral feeding after total laryngectomy may not be necessary to prevent pharyngocutaneous fistulae.
• Earlier oral feeding could enhance patient comfort and reduce hospital length of stay without increasing complication rates.
• Pyriform sinus tumors are associated with increased fistula risk, while prior radiotherapy and neck dissection showed no significant effect.