Early oral feeding following total laryngectomy.
BACKGROUND
Pharyngocutaneous fistula is one of the most common nonfatal laryngectomy complications (7.6% to 65% of all total patients). Preoperative radiotherapy, advanced tumor stage, poor preoperative medical status, and concomitant pharyngectomy are usually accepted causative factors in fistula formation. Delay of oral feeding is a common practice used by head and neck surgeons to prevent the development of pharyngocutaneous fistula. In this article we analyze our experience with special emphasis given to the early start of postoperative feeding.


METHODS
The postoperative records of 48 patients who had undergone total laryngectomy or total laryngopharyngectomy were reviewed. All patients were orally fed with water and clear liquids on the first postoperative day. The patients were closely observed at every feeding attempt, and if any sign of fistula was noted, a nasogastric tube was inserted. Preoperative radiotherapy, stage of disease, tumor differentiation, and pharyngectomy with total laryngectomy were statistically analyzed as potential risk factors contributing to fistula formation. The Fisher exact test was used to analyze the data.


RESULTS
The overall pharyngocutaneous fistula rate was 12.5% in our series. The only statistically significant factor that increased the rate of fistula formation was resection of pharyngeal mucosa as an extension of total laryngectomy. Other parameters failed to show any statistical significance in development of this complication.


CONCLUSIONS
Evaluation of fistula incidence in our series indicates that initiating oral feeding on the first postoperative day does not contribute to fistula formation. Additionally, the relatively shortened hospital stay and elimination of the psychologic and traumatic side effects of tube feeding are benefits of this approach that should be studied in further prospective quality-of-life studies.
Saydam
Levent
L
Department of Otolaryngology, Bayindir Medical Center, Ankara; and the Department of Otolaryngology, Inonu University Medical School, Malatya, Turkey.
Kalcioglu
Tayyar
T
Kizilay
Ahmet
A
D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D017577:Cutaneous Fistula / Q000209:etiology* / Q000473:pathology / Q000517:prevention & control*; D016154:Digestive System Fistula / Q000209:etiology* / Q000473:pathology / Q000517:prevention & control*; D004750:Enteral Nutrition / Q000009:adverse effects*; D005260:Female; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007825:Laryngectomy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010608:Pharyngeal Diseases / Q000209:etiology* / Q000473:pathology; D011183:Postoperative Complications; D012189:Retrospective Studies; D013997:Time Factors