title: Early oral feeding after total laryngectomy: A systematic review.
abstract: BACKGROUND
  Early oral feeding for patients who underwent total laryngectomy is still controversial. The purpose of this study was to evaluate the safety of initiating early oral feeding after total laryngectomy regarding pharyngocutaneous fistula. The survey included research in MEDLINE, EMBASE, and LILACS.
  
  
  METHODS
  The intervention analyzed was early oral feeding (<5 days), whereas the control group received late oral feeding (>7 days) after total laryngectomy.
  
  
  RESULTS
  From 304 studies, 4 randomized clinical trials with 180 patients were selected. In the early oral feeding group, the incidence was 6.7%, whereas in the late oral feeding group it was 10%, with no statistically significant difference (IC95% -0.11 to 0.05; p = .42; I(2)  = 0%). Four cohort studies with 490 patients were also selected. In the early oral feeding group, the incidence was 12.2%, whereas in the other group, it was 10.1%, with no statistically significant difference (IC95% -0.05 to 0.08; p = .67; I2  = 0%).
  
  
  CONCLUSIONS
  There is no increase in pharyngocutaneous fistula rates in patients who receive early oral feeding after total laryngectomy.
authors.affiliation: Department of Surgery, Hospital Ana Costa, Santos, Brazil.
authors.forename: Felipe Toyama
authors.initials: FT
authors.lastname: Aires
authors.affiliation: Department of Head and Neck Surgery, Hospital das Clínicas, University of São Paulo School of Medicine, São Paulo, Brazil.
authors.forename: Rogério Aparecido
authors.initials: RA
authors.lastname: Dedivitis
authors.affiliation: Department of Head and Neck Surgery, Hospital Ana Costa, Santos, Brazil.
authors.forename: Sílvia Miguéis Picado
authors.initials: SM
authors.lastname: Petrarolha
authors.affiliation: Department of Evidence Based Medicine, Medical Sciences School of Santos - UNILUS, Santos, Brazil.
authors.forename: Wanderley Marques
authors.initials: WM
authors.lastname: Bernardo
authors.affiliation: Department of Head and Neck Surgery, University of São Paulo School of Medicine, São Paulo, Brazil.
authors.forename: Claudio Roberto
authors.initials: CR
authors.lastname: Cernea
authors.affiliation: Department of Head and Neck Surgery, University of São Paulo School of Medicine, São Paulo, Brazil.
authors.forename: Lenine Garcia
authors.initials: LG
authors.lastname: Brandão
mesh_terms: D003251:Constriction, Pathologic / Q000209:etiology; D017577:Cutaneous Fistula / Q000209:etiology*; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D006801:Humans; D007822:Laryngeal Neoplasms / Q000601:surgery*; D007825:Laryngectomy; D008297:Male; D010608:Pharyngeal Diseases / Q000209:etiology*; D011182:Postoperative Care; D011183:Postoperative Complications; D011795:Surveys and Questionnaires; D013997:Time Factors
keywords: carcinoma; cutaneous fistula; enteral nutrition; laryngeal neoplasms; laryngectomy; meta-analysis; postoperative complications; squamous cell