Oral feeding after total laryngectomy

Abstract

Pharyngocutaneous fistulae occur in 15%-25% of patients after total laryngectomy. Factors that may predispose to fistulae formation include prior radiation, surgical technique, tumor size and location, and patient nutritional status. In addition, many surgeons believe that the timing of oral feeding after surgery contributes to fistula development. Thus, they advocate delaying feeding postoperatively, especially in high-risk patients. The traditional guideline has been to wait until the seventh postoperative day. The purpose of this study was to examine the relationship between the timing of postoperative oral feeding and the development of pharyngocytaneous fistulae after total laryngectomy with primary closure in patients with squamous cell carcinoma. A questionnaire was sent to 210 members of the American Society for Head and neck Surgery to determine practice patterns toward feeding after laryngectomy. We also reviewed the records of 137 patients who underwent total laryngectomy at the University of Colorado Health Sciences Center and the Denver VA Medical Center from January 1975 through December 1987. Of the surgeons polled, 84.5% waited at least 7 days after surgery to begin oral feeding. However, in reviewing 94 patients eligible for study, we found no difference in the rate of fistula formation between patients fed on or before the fifth postoperative day and those fed on or after the sixth postoperative day. In fact, most fistulae were evident before the patient started oral feeding. Pyriform sinus tumors were predisposed to fistulae but prior radiotherapy and neck dissection seemed to have no effect. Earlier oral feeding after total laryngectomy may improve patient comfort and shorten hospital stay without increasing the incidence of complications.(ABSTRACT TRUNCATED AT 250 WORDS)

Early oral feeding following total laryngectomy

“…Advanced tumour stage is associated with more frequent pre-operative tracheostomy, wider surgical resection and a higher likelihood of neck dissection. These factors have been reported in some studies to predispose to pharyngocutaneous fistulae, 3,33,38,45 while others have found no such association. 1,37,41,46 No such association was found in our study.…”

The prognostic value of abnormal findings on radiographic swallowing studies after total laryngectomy

“…Common practice among head and neck surgeons is to withhold oral feeding for at least 7 days after total laryngectomy [17] , because it is generally believed that early feeding can increase the incidence of fistula formation. However, it is well known that even in the non-feeding state, saliva is constantly swallowed during the early postoperative period, and the pharynx is never really at rest after total laryngectomy [12,17] .…”

Inzidenz von Speichelfisteln in Abhängigkeit vom Zeitpunkt einer oralen Ernährung nach Laryngektomie

“…Zurückgeführt werden kann diese Meinung wohl auf die 50er und 60er Jahre als u. a. von Kirchner diskutiert wurde, dass der orale Schluckakt die Pharynxnaht belastet (Übersicht in [4]). Dieser Auffassung als Begründung für eine längere postoperative Sondenernährung muss schon insofern widersprochen werden, als auch ohne orale Nahrungsaufnahme durch das Schlucken von Speichel die Pharynxnaht ständig belastet ist.…”

“…Einige Ergebnisse aus der Literatur sprechen bei kleineren Fisteln ohne eine Gefährdung großer Halsgefäße eher gegen eine übereilte operative Intervention [1,4,8,20,24].Hier muss der Einfluss einer oralen Ernährung auf den spontanen Fistelverschluss überprüft werden. Bei größeren Fisteln, Gefährdung großer Gefäße und/oder einer geplanten Nachbestrahlung sind jedoch chirurgische Sekundärinterventionen häufig unumgäng-lich [3],wie es auch im eigenen Patientengut zu beobachten war.…”

“…So wird in den USA von den meisten Chirurgen ein oraler Nahrungsaufbau nach dem 7. postoperativen Tag praktiziert (Übersicht in [4]). Einige Autoren postulieren sogar einen gänzlichen Verzicht auf eine Nährsonde und einen oralen Nahrungsaufbau ab dem 1. bis 3. postoperativen Tag [1,2,25].…”