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Does early oral feeding increase the likelihood of salivary fistula after total laryngectomy?

Published online by Cambridge University Press:  15 April 2014

A A Sousa*
Affiliation:
Instituto Alfa de Gastroenterologia, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
J M Porcaro-Salles
Affiliation:
Instituto Alfa de Gastroenterologia, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
J M A Soares
Affiliation:
Department of Medicine, Universidade Federal de São João Del Rei, Divinópolis, Minas Gerais, Brazil
G M de Moraes
Affiliation:
Instituto Alfa de Gastroenterologia, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
G S Silva
Affiliation:
Instituto Alfa de Gastroenterologia, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
R A Sepulcri
Affiliation:
Department of Medicine, Universidade Federal de São João Del Rei, Divinópolis, Minas Gerais, Brazil
P R Savassi-Rocha
Affiliation:
Instituto Alfa de Gastroenterologia, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
*
Address for correspondence: Dr. Alexandre Andrade Sousa, Avenida do Contorno 5351 sala 1206, Bairro Cruzeiro, CEP 30.310-035 Belo Horizonte, MG, Brazil Fax: (55)31-2535-1800 E-mail: [email protected]

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.

Conclusion:

The early reintroduction of oral feeding in total laryngectomised patients did not increase the incidence of salivary fistula.

Type
Main Articles
Copyright
Copyright © JLO (1984) Limited 2014 

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References

1Forastiere, A, Koch, W, Trotti, A, Sidransky, D. Head and neck cancer. N Eng J Med 2001;345:1890–900CrossRefGoogle ScholarPubMed
2Saki, N, Nikakhlagh, S, Kazemi, H. Pharyngocutaneous fistula after laryngectomy: incidence, predisposing factors, and outcome. Arch Iran Med 2008;11:314–17Google Scholar
3Soylu, L, Kiroglu, M, Aydogan, B. Pharyngocutaneous fistula following laryngectomy. Head Neck 1998;20:22–5Google Scholar
4Redaelli de Zinis, LO, Ferrari, L, Tormenzoli, D, Premoli, G, Parrinello, G, Nicolai, P. Postlaryngectomy pharyngocutaneous fistula: incidence, predisposing factors, and therapy. Head Neck 1999;21:131–83.0.CO;2-F>CrossRefGoogle ScholarPubMed
5Palomar, AV, Sarroca, CE, Tobiaz, GS, Pérez Hernández, I, Palomar-García, V. Pharyngocutaneous fistula following total laryngectomy. A case-control study of risk factors implicated in this onset [in Spanish]. Acta Otorrinolaringol Esp 2008;59:480–4Google Scholar
6Assis, LAP, Negri, SLC, Oliveira, EL, Filho, LF, Pires, ESB. Pharyngocutaneous fistula after total laryngectomy: experience from Mário Penna Hospital [in Portuguese]. Rev Bras Cirur Cabeça Pescoço 2004;33:7781Google Scholar
7Qureshi, SS, Chatuverdi, P, Pai, OS, Chaukar, DA, Deshpande, MS, Pathak, KA et al. Pharyngocutaneous fistula after total laryngectomy: a systematic review. J Cancer Res Ther 2005;1:51–6Google Scholar
8Trinidad Ruiz, G, Luengo Pérez, LM, Marcos García, M, Pardo Romero, G, González Palomino, A, Pino Rivero, V et al. Value of nutritional support in patients with pharingocutaneous fistula [in Spanish]. Acta Otorrinolaringol Esp 2005;56:2530CrossRefGoogle ScholarPubMed
9Saydam, L, Kalcioglu, T, Kizilay, A. Early oral feeding following total laryngectomy. Am J Otolaryngol 2002;23:277–81Google Scholar
10Sharifian, HA, Najafi, M, Khajavi, M. Early oral feeding following total laryngectomy. Tanaffos 2008;7:6470Google Scholar
11Medina, JE, Khafif, A. Early oral feeding following total laryngectomy. Laryngoscope 2001;111:368–72Google Scholar
12Seven, H, Calis, AB, Turgut, S. A randomized controlled trial of early oral feeding in laryngectomized patients. Laryngoscope 2003;113:1076–9Google Scholar
13Akyol, MU, Ozdem, C, Celikkanat, S. Early oral feeding after total laryngectomy. Ear Nose Throat J 1995;74:2830Google Scholar
14Prasad, KC, Sreedharan, S, Dannana, NK, Prasad, SC, Chandra, S. Early oral feeds in laryngectomized patients. Ann Otol Rhinol Laryngol 2006;115:433–8CrossRefGoogle ScholarPubMed
15Boyce, SE, Meyers, AD. Oral feeding after total laryngectomy. Head Neck 1989;11:269–73Google Scholar
16Edge, SB, Byrd, DR, Compton, CC, Fritz, AG, Greene, FL, Trotti, A, eds. American Joint Committee on Cancer (AJCC) Cancer Staging Manual, 7th edn.New York: Springer, 2009Google Scholar
17Aswani, J, Thandar, M, Otiti, J, Fagan, J. Early oral feeding following total laryngectomy. J Laryngol Otol 2009;123:333–8Google Scholar
18Aprigliano, F. Use of the nasogastric tube after total laryngectomy: is it truly necessary? Ann Otol Rhinol Laryngol 1990;99:513–14CrossRefGoogle ScholarPubMed
19Song, J, Jing, S, Shi, H. The clinical observation of early oral feeding following total laryngectomy [in Chinese]. Lin Chuang Er Bi Yan Hou Ke Za Zhi 2003;17:527–8Google Scholar
20Volling, P, Singelmann, H, Ebeling, O. Incidence of salivary fistulas in relation to timing of oral nutrition after laryngectomy [in German]. HNO 2001;49:276–82CrossRefGoogle ScholarPubMed
21Eustaquio, M, Medina, JE, Krempl, GA, Hales, N. Early oral feeding after salvage laryngectomy. Head Neck 2009;31:1341–5Google Scholar
22Paydarfar, JA, Birkmeyer, NJ. Complications in head and neck surgery: a meta-analysis of postlaryngectomy pharyngocutaneous fistula. Arch Otolaryngol Head Neck Surg 2006;132:6772Google Scholar
23Sousa, AA, Castro, SBO, Porcaro-Salles, JM, Soares, JM, de Moraes, GM, Carvalho, JR et al. The usefulness of a pectoralis major myocutaneous flap in preventing salivary fistulae after salvage total laryngectomy. Braz J Otorhinolaryngol 2012;78:103–7CrossRefGoogle ScholarPubMed
24Markou, KD, Vlachtsis, KC, Nikolaou, AC, Petridis, DG, Kouloulas, AI, Daniilidis, IC. Incidence and predisposing factors of pharyngocutaneous fistula formation after total laryngectomy. Is there a relationship with tumour recurrence? Eur Arch Otorhinolaryngol 2004;261:61–7CrossRefGoogle Scholar
25Galli, J, De Corso, E, Volante, M, Almadori, G, Paludetti, G. Postlaryngectomy pharyngocutaneous fistula: incidence, predisposing factors, and therapy. Otolaryngol Head Neck Surg 2005;133:689–94CrossRefGoogle ScholarPubMed
26Lorenz, KJ, Grieser, L, Ehrhart, T, Maier, H. Role of reflux in tracheoesophageal fistula problems after laryngectomy. Ann Otol Rhinol Laryngol 2010;119:719–28Google Scholar
27Queija Ddos, S, Portas, JG, Dedivitis, RA, Lehn, CN, Barros, AP. Swallowing and quality of life after total laryngectomy and pharyngolaryngectomy. Braz J Otorhinolaryngol 2009;75:556–64Google ScholarPubMed
28Schwartz, SR, Yueh, B, Maynard, C, Daley, J, Henderson, W, Khuri, SF. Predictors of wound complications after laryngectomy: a study of over 2000 patients. Otolaryngol Head Neck Surg 2004;131:61–8Google Scholar
29Boscolo-Rizzo, P, De Cillis, G, Marchiori, C, Carpenè, S, Da Mosto, MC. Multivariate analysis of risk factors for pharyngocutaneous fistula after total laryngectomy. Eur Arch Otorhinolaryngol 2008;265:929–36CrossRefGoogle ScholarPubMed
30Dedivitis, RA, Ribeiro, KC, Castro, MA, Nascimento, PC. Pharyngocutaneous fistula following total laryngectomy. Acta Otorhinolaryngol Ital 2007;27:25Google ScholarPubMed
31Cavalot, AL, Gervasio, CF, Nazionale, G, Albera, R, Bussi, M, Staffieri, A et al. Pharyngocutaneous fistula as a complication of total laryngectomy: review of the literature and analysis of case records. Otolaryngol Head Neck Surg 2000;123:587–92Google Scholar
32Ikiz, AO, Uça, M, Güneri, EA, Erdağ, TK, Sütay, S. Pharyngocutaneous fistula and total laryngectomy: possible predisposing factors, with emphasis on pharyngeal myotomy. J Laryngol Otol 2000;114:768–71CrossRefGoogle ScholarPubMed
33Correia, MI, Waitzberg, DL. The impact of malnutrition on morbidity, mortality, length of hospital stay and costs evaluated through a multivariate model analysis. Clin Nutr 2003;22:235–9CrossRefGoogle ScholarPubMed
34Campos, ACL, Chen, M, Meguid, MM. Comparisons of body composition derived from anthropomorphic and bioelectrical impedance methods. J Am Coll Nutr 1989;8:189–95Google Scholar