Research On Early Oral Feeding And Formation Of Pharyngocutaneous Fistula After Total Laryngectomy

Objective:To explore whether early oral after total laryngectomy is safe and effective by evaluating the incidence of pharyngocutaneous fistula(PCF)and the hospital duration.Meanwhile,to identify the potential risk factors of PCF formation.Methods:A retrospective cohort study was conducted,including patients with laryngeal carcinoma or hypopharyngeal carcinoma who underwent total laryngectomy plus(n=2)/not plus partial tongue base resection,plus(n=1)/not plus partial pharyngectomy,with(n=2)/without pedicle flaps in our Head and Neck Surgery Department between 2012.Jan to 2017.Oct.Patients who had a history of preoperative radiotherapy,chemotherapy or chemoradiotherapy,or who had previous surgery for larynx or pharynx,or who had severe complications were excluded.The total patients in this study was 52(n=52).Early oral feeding started within 48-72h postoperative,while delayed oral feeding started within postoperative day 8-10.We compared the incidence of PCF between these two groups in order to evaluate whether PCF and early oral feeding are related.Meanwhile,a multi-variables analysis was conducted to explore whether early oral feeding is a single risk factor of PCF while other pertinent variables were taken into account.A comparison of the hospital duration and the postoperative hospital duration was conducted both in early oral feeding patients/delayed oral feeding patients and early oral feeding PCF free patients/delayed oral feeding PCF free patients.Results:The overall PCF rate was 19.2%.PCF rate in early oral feeding patients is 11.1%with 23.5%in delayed oral feeding patients.No significant statistic difference of PCF rate was found between these two groups in univariable analysis(Continuous correlation chi square test,x2=0.506,P=0.477).In multi-variables analysis,oral feeding time(early or delayed)was not an independent risk factor of PCF(Two classification response variable Logistic regression,P=0.224,OR=0.253,95%CI[0.028-2.322]).But low preoperative albumin level was observed as an independent risk factor of PCF development(Two classification response variable Logistic regression,P=0.039,OR=0.846,95%CI[0.722-0.992]).A negative correlation was observed between preoperative albumin level and PCF.We also observed that the hospital duration and postoperative duration between early oral feeding patients and delayed oral feeding patients was with no significant difference(Mann-Whitney U test,P>0.05).No statistic difference of the hospital duration and postoperative duration either between early oral feeding PCF free patients and delayed oral feeding PCF free patients(Mann-Whitney U test,P>0.05).Conclusions:For patients who underwent primary total laryngectomy with no previous history of radiotherapy,chemotherapy,chemoradiotherapy,early oral feeding is safe and effective,but seems not able to decrease hospital duration.Patients with a relative low albumin level are more likely to develop a PCF.