Early oral feeding after total laryngectomy: Outcome of 602 patients in one cancer center.
OBJECTIVE
Pharyngocutaneous fistula (PCF) is the most frequent complication after total laryngectomy. However, delayed oral feeding and inserting a nasogastric tube has been considered as a safe practice among head and neck surgeons, and there is no general agreement on the initiation of the oral intake. The aim of the study is to determine the incidence of PCF after primary total laryngectomy in a large homogenous case series and to evaluate whether fistula and early oral feeding are related.


METHODS
Patients who underwent total laryngectomy/laryngopharyngectomy with primary closure of pharynx between 1990 and 2014 were reviewed. Patients who had a history of previous radiotherapy, chemotherapy or chemoradiotherapy, and patients who underwent more complex reconstruction techniques (e.g. pedicled or free flaps) for closure were excluded. In total, 602 patients underwent total laryngectomy (n=580) or total laryngectomy plus partial pharyngectomy (n=22).


RESULTS
The overall PCF rate was 12%. In 582 of the 602 patients (99.8%), a nasogastric tube was not inserted. In 95.7% of the patients (576/602), oral feeding was started within 3 days of surgery. Among the patients who developed PCF (72/602), PCF rate was not significantly higher in early oral fed patients (69/582, 11.8%) than the patients with nasogastric tube insertion (3/20, 15%) (p=0.722).


CONCLUSION
The low PCF rate in our study indicates that early oral feeding is a safe and effective method in primary total laryngectomy.
['Süslü|Nilda|N|', 'Şefik Hoşal|A|A|']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D002277:Carcinoma D017577:Cutaneous Fistula D005248:Feeding Methods D005260:Female D006801:Humans D007822:Laryngeal Neoplasms D007825:Laryngectomy D008297:Male D008875:Middle Aged D010608:Pharyngeal Diseases D010610:Pharyngeal Neoplasms D010611:Pharyngectomy D011182:Postoperative Care D011183:Postoperative Complications D012189:Retrospective Studies D013997:Time Factors D055815:Young Adult
Early oral feeding Total laryngectomy Phayngocutaneous fistula