Management of oral feeding following total laryngectomy around the world: YO‐IFOS international study (original) (raw)
Related papers
The practice of oral feeding after total laryngectomy by Brazilian head and neck surgeons
Archives of Head and Neck Surgery
Introduction: This is an international survey on the timing of oral feeding after total laryngectomy (TL). Among the 332 responses received, 75 were from Brazilian head and neck surgeons. This subgroup of respondents was analyzed because of its proportionally large contribution. Objective: To evaluate the initiation of oral feeding in patients following TL by a group of Brazilian head and neck surgeons. Methods: Online survey-75 responders from Brazil. Results: 40.5% of the respondents introduced water and 41.9% of them introduced liquid diets between days 7 and 9 after TL without surgical complications or previous radiotherapy. Semi-solid feeds were started between days 10 and 14 in 47.3% of the patients and a free diet was begun after day 15 in 79.7% of them. There was statistically significant difference in the initiation of liquid feeds between different groups of TL patients, with earlier initiation in TL patients who had not undergone prior radio(chemo)therapy (p=0.01419), with even greater differences when complex closure of the pharynx was needed (p=0.00001), but not regarding the moment of a free diet introduction. Conclusion: Most respondents in this Brazilian cohort prefer to wait at least 7 days before beginning oral feeding after TL without previous radiotherapy or surgical complications, with a significant number of respondents postponing feeds in patients who had undergone salvage TL and pharyngolaryngectomy.
Early oral feeding following total laryngectomy: A systematic review
Head & Neck, 2014
Early oral feeding (EOF) for patients who underwent total laryngectomy (TL) is still controversial. Aim: To evaluate the safety of initiating EOF following TL regarding pharyngocutaneous fistula (PCF). Data Sources: The survey included research in MEDLINE, EMBASE and LILACS. Review methods: The intervention analyzed was EOF (<5days), whereas the control group received late oral feeding (>7days) after TL. Results: From 304 studies, 4 randomized clinical trials with 180 patients were selected. In the EOF group, the incidence was 6.7%, whereas in the late oral feeding group, it was 10%, with no statistically significant difference (IC 95% -0.11-0.05; p=0.42; I 2 =0%). Four cohort studies with 490 patients were also selected. In the EOF group, the incidence was 12.2%, whereas in the other, it was 10.1%, with no statistically significant difference (IC 95% -0.05-0.08; p=0.67; I 2 =0%). Conclusion:
Early oral feeding following total laryngectomy
American Journal of Otolaryngology, 2002
Introduction: 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.
Oral feeding after total laryngectomy for endolaryngeal cancer
European Archives of Oto-Rhino-Laryngology, 1995
There is still no agreement about the beginning of oral feedings after total laryngectomy. Some authors begin routine feedings on the 3rd postoperative day, while others delay oral feedings until 12-14 days after surgery. The present study was devised as a prospective randomized clinical trial concerning beginning oral feedings on the 7th or 14th postoperative day in 35 patients following total laryngectomy as treatment for endolaryngeal cancer. There were no differences in risk factors present in either group. Only two pharyngocutaneous fistulae occurred in the overall series (5.7%), with both appearing in the 7-day group and developing on the 18th and 20th postoperative days respectively. There were no statistically significant differences in fistula formation between the two groups (P = 0.49). We conclude that it is not necessary to delay oral feedings more than 7 days in patients without suture line tension.
Assessment of nutritional parameter outcome in laryngeal cancer patients undergoing laryngectomy
Iranian Journal of Otorhinolaryngology, 2010
Introduction: Laryngectomy in patients with laryngeal cancer can lead to the reduction of nutritional parameters. Supportive treatments and supplementary nutritional supports are recommended in all patients undergoing laryngectomy, even with acceptable preoperative nutritional indices. The aim of this study was to evaluate postoperative changes in nutritional parameters in patients with laryngeal cancer undergoing laryngectomy. Materials and Methods: In a prospective study from 2005 to 2007, 30 candidate patients for total laryngectomy in Amir Alam Hospital in Tehran were included for final diagnosis of squamous cell carcinoma (stage T 4). Nutritional parameters including body mass index (BMI), serum levels of albumin, hemoglobin, total protein concentration, total lymphocyte number and percentage were assessed one week before and one month after laryngectomy. All patients used their routine dietary regimens and those who received nutritional supplementation after surgery were excluded from the study. Results: Except for white blood cell count, a significant reduction was found in BMI, lymphocyte count, serum hemoglobin, total protein and albumin levels after surgery (P<0.001). There were no significant differences between the change in nutritional parameters after laryngectomy and the increase in age; BMI (P=0.054), hemoglobin (P=0.406), total protein (P=0.103), and albumin (P=0.132), postoperative length of hospital stay and concomitant neck dissection. Conclusion: Laryngectomy in patients with laryngeal cancer leads to the reduction of nutritional parameters but these changes do not depend on the patient's age, concurrent neck dissection and length of hospital stay; however, the supportive approaches can also be recommended in patients leaving hospital without any serious complications.
European Archives of Oto-Rhino-Laryngology
Purpose Malnutrition is an important prognostic indicator of post-operative outcomes in patients undergoing surgery for head and neck cancer, however, limited studies utilize validated nutrition assessment tools to accurately assess risk. The aim of this study was to determine the relationship between nutritional status on post-operative complications and length of stay for patients undergoing either a laryngectomy, pharyngectomy or pharyngolaryngectomy for head and neck cancer. Methods Patients with head and neck cancer undergoing a laryngectomy, pharyngectomy or pharyngolaryngectomy at a tertiary hospital in Australia were eligible for this retrospective cohort study (n = 40). Nutritional status was assessed by the dietitian on admission using the validated Subjective Global Assessment tool. Clinical outcomes were collected via retrospective chart review and included length of stay and post-operative complications. Results Pre-operative malnutrition incidence was 40%. Malnourished...
Annals of Otology, Rhinology, and Laryngology, 2019
Objectives: Standards of care for total laryngectomy (TL) patients in the postoperative period have not been established. Perioperative care remains highly variable and perhaps primarily anecdotally based. The aim of this study was to survey members of the American Head and Neck Society to capture management practices in the perioperative care of TL patients. Methods: In this survey study, an electronic survey was distributed to the international attending physician body of the American Head and Neck Society. Forty-five-question electronic surveys were distributed. A total of 777 members were invited to respond, of whom 177 (22.8%) fully completed the survey. The survey elicited information on management preferences in the perioperative care of TL patients. Differences in management on the basis of irradiation status and pharyngeal repair (primary closure vs regional or free flap reconstruction) were ascertained. Main outcomes and measures were time to initiate oral feeding, perioperative antibiotic selection and duration, and estimated pharyngocutaneous fistula rates. These measures were stratified by patient type. Results: Most respondents completed head and neck fellowships (77.0%) and practice at academic tertiary centers (72.3%). Ampicillin/sulbactam was the most preferred perioperative antibiotic (43.2%-49.1% depending on patient type), followed by cefazolin and metronidazole in combination (32.0%-33.7%) and then clindamycin (10.8%-12.6%). Compared with nonirradiated patients, irradiated patients were significantly more likely to have longer durations of antibiotics (P < .05), longer postoperative times to initiate oral feeding (P < .05), and higher estimated fistula rates (P < .05). Additionally, in nonirradiated patients, flap-repaired patients (vs primary repair) were significantly more likely to have longer durations of antibiotics (odds ratio, 1.29; 95% confidence interval, 1.13-1.48) and postoperative times to initiate oral feeding (odds ratio, 2.24; 95% confidence interval, 1.76-2.84). Conclusions: Perioperative management of TL patients is highly variable. Management of antibiotics and oral feeding are significantly affected by irradiation status and scope of pharyngeal repair. Further studies are needed to standardize perioperative care for this unique patient population.
The importance of preoperative swallowing therapy in subtotal laryngectomies
Otolaryngology - Head and Neck Surgery, 2009
To examine the utility of swallowing therapy (ST) before and after surgery in patients undergoing subtotal laryngectomy. STUDY DESIGN AND SETTING: From 1990 to 2000, 43 patients underwent subtotal laryngectomy. Prior to 1997 patients received ST only after surgery, while from 1997 on, patients scheduled for subtotal laryngectomy also received some sessions of ST before surgery.
Post-laryngectomy: it's hard to swallow
Dysphagia, 2009
The prevalence of swallowing disorders (dysphagia) following a total laryngectomy remains unknown, with estimates varying from 17 to 70%. The primary aim of this study was to investigate the prevalence and nature of self-reported dysphagia following a total laryngectomy across New South Wales (NSW), Australia. A secondary aim was to document the effect of dysphagia on the respondents' social activities and participation. A questionnaire battery, with a prepaid envelope for return, was sent to all laryngectomy members (n = 197) of the Laryngectomee Association of NSW. One hundred twenty questionnaires (61%) were completed and returned. Dysphagia was self-reported by 71.8% of the cohort. In this cohort with dysphagia, the most commonly reported features included an increased time required to swallow, a need for fluids to wash down a bolus, and avoidance of certain food consistencies. Severe distress was reportedly associated with dysphagia for 39.7% of these respondents and prevented 57% of them from participating in social activities, such as eating at friends' houses and/or at restaurants. The prevalence of self-reported dysphagia following total laryngectomy in this Australian study was 72%. Dysphagia can result in laryngectomees making significant changes to their diets and it has a marked impact on their activities and social participation.