title: Does early oral feeding increase the likelihood of salivary fistula after total laryngectomy?
abstract: OBJECTIVE
  This study compared the incidence of salivary fistula between groups with an early or late reintroduction of oral feeding, and identified the predictive factors for salivary fistula.
  
  
  METHODS
  A randomised trial was performed using 89 patients with larynx or hypopharynx cancer, assigned to 2 groups (early or late). In the early group, oral feeding was started 24 hours after total laryngectomy or total pharyngolaryngectomy, and in the late group, it was started from post-operative day 7 onwards. The occurrence of salivary fistula was evaluated in relation to the following variables: early or late oral feeding, nutritional status, cancer stage, surgery performed, and type of neck dissection.
  
  
  RESULTS
  The incidence of salivary fistula was 27.3 per cent (n= 12) in the early group and 13.3 per cent (n= 6) in the late group (p= 0.10). The following variables were not statistically significant: nutritional status (p= 0.45); tumour location (p= 0.37); type of surgery (p= 0.91) and type of neck dissection (p= 0.62). A significant difference (p= 0.02) between the free margins and invasive carcinoma was observed.
  
  
  CONCLUSIONS
  The early reintroduction of oral feeding in total laryngectomised patients did not increase the incidence of salivary fistula.
authors.affiliation: Instituto Alfa de Gastroenterologia, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
authors.forename: A A
authors.initials: AA
authors.lastname: Sousa
authors.affiliation: Instituto Alfa de Gastroenterologia, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
authors.forename: J M
authors.initials: JM
authors.lastname: Porcaro-Salles
authors.affiliation: Department of Medicine, Universidade Federal de São João Del Rei, Divinópolis, Minas Gerais, Brazil.
authors.forename: J M A
authors.initials: JMA
authors.lastname: Soares
authors.affiliation: Instituto Alfa de Gastroenterologia, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
authors.forename: G M
authors.initials: GM
authors.lastname: de Moraes
authors.affiliation: Instituto Alfa de Gastroenterologia, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
authors.forename: G S
authors.initials: GS
authors.lastname: Silva
authors.affiliation: Department of Medicine, Universidade Federal de São João Del Rei, Divinópolis, Minas Gerais, Brazil.
authors.forename: R A
authors.initials: RA
authors.lastname: Sepulcri
authors.affiliation: Instituto Alfa de Gastroenterologia, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
authors.forename: P R
authors.initials: PR
authors.lastname: Savassi-Rocha
mesh_terms: D006801:Humans; D007825:Laryngectomy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D005260:Female; D000368:Aged; D007822:Laryngeal Neoplasms / Q000601:surgery; D012467:Salivary Gland Fistula / Q000209:etiology / Q000453:epidemiology; D007012:Hypopharyngeal Neoplasms / Q000601:surgery; D013997:Time Factors; D000328:Adult; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D004750:Enteral Nutrition / Q000009:adverse effects / Q000379:methods; D012307:Risk Factors; D010611:Pharyngectomy / Q000009:adverse effects / Q000379:methods; D037981:Neck Dissection / Q000009:adverse effects; D015994:Incidence; D009752:Nutritional Status
keywords: Enteral Nutrition; Laryngectomy; Pharyngectomy; Postoperative Complications; Protein-Calorie Malnutrition; Risk Factors