Archives of Head and Neck Surgery
Archives of Head and Neck Surgery

The practice of oral feeding after total laryngectomy by Brazilian head and neck surgeons

Johanna Benali, Tareck Ayad, Fabio Pupo Ceccon, Carlos Chiesa-Estomba, Jerome R. Lechien, Mateus Morais Aires, Leonardo Haddad, Gerrit Viljoen, Nicolas Fakhry

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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.


laryngectomy; postoperative care; postoperative complications


1. Bozec A, Culié D, Poissonnet G, Dassonville O. Current role of total laryngectomy in the era of organ preservation. Cancers (Basel). 2020;12(3):584. http://dx.doi. org/10.3390/cancers12030584. PMid:32138168.

2. Hasan Z, Dwivedi RC, Gunaratne DA, Virk SA, Palme CE, Riffat F. Systematic review and meta-analysis of the complications of salvage total laryngectomy. Eur J Surg Oncol. 2017;43(1):42-51. PMid:27265037.

3. Sayles M, Grant DG. Preventing pharyngo‐cutaneous fistula in total laryngectomy: a systematic review and meta‐analysis. Laryngoscope. 2014;124(5):1150-63. http:// PMid:24122657.

4. Wang M, Xun Y, Wang K, Lu L, Yu A, Guan B, Yu C. Risk factors of pharyngocutaneous fistula after total laryngectomy: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol. 2020;277(2):585-99. 05718-9. PMid:31712878.

5. Casasayas M, Sansa A, García-Lorenzo J, López M, Orús C, Peláez X, Quer M, León X. Pharyngocutaneous fistula after total laryngectomy: multivariate analysis of risk factors and a severity-based classification proposal. Eur Arch Otorhinolaryngol. 2019;276(1):143-51. 5200-4. PMid:30426230.

6. Dedivitis RA, Aires FT, Cernea CR, Brandao LG. Pharyngocutaneous fistula after total laryngectomy: systematic review of risk factors. Head Neck. 2015;37(11):1691-7. PMid:24958209.

7. Cavalot AL, Gervasio C-F, Nazionale G, Albera R, Bussi M, Staffieri A, Ferrero V, Cortesina G. Pharyngocutaneous fistula as a complication of total laryngectomy: review of the literature and analysis of case records. Otolaryngol Head Neck Surg. 2000;123(5):587-92. PMid:11077346.

8. Busoni M, Deganello A, Gallo O. Pharyngocutaneous fistula following total laryngectomy: analysis of risk factors, prognosis and treatment modalities. Acta Otorhinolaryngol Ital. 2015;35(6):400-5. 100X-626. PMid:26900245.

9. Paydarfar JA, Birkmeyer NJ. Complications in head and neck surgery: a metaanalysis of postlaryngectomy pharyngocutaneous fistula. Arch Otolaryngol Head Neck Surg. 2006;132(1):67-72. PMid:16415432.

10. Lagier A, Mimouni-Benabu O, Baumstarck K, Boulogne O, Michel J, Benabu D, Dessi P, Giovanni A, Fakhry N. The influence of age on postoperative complications after total laryngectomy or pharyngolaryngectomy. Eur J Surg Oncol. 2014;40(2):202-7. PMid:24071365.

11. Dedo DD, Alonso WA, Ogura JH. Incidence, predisposing factors and outcome of pharyngocutaneous fistulas complicating head and neck cancer surgery. Ann Otol Rhinol Laryngol. 1975;84(6):833-40. http://dx.doi. org/10.1177/000348947508400616. PMid:1053455.

12. De Jong PC, Struben WH. Pharyngeal fistulae after laryngectomy. J Laryngol Otol. 1970;84(9):897-903. PMid:4990561.

13. Medina JE, Khafif A. Early oral feeding following total laryngectomy. Laryngoscope. 2001;111(3):368-72. PMid:11224763.

14. Soylu L, Kıroğlu M, Aydoğan B, Çetik F, Kıroğlu F, Akçalı Ç, Ozşahinoglu C. Pharyngocutaneous fistula following laryngectomy. Head Neck. 1998;20(1):22-5.;2-5. PMid:9464948.

15. Seven H, Calis AB, Turgut S. A randomized controlled trial of early oral feeding in laryngectomized patients. Laryngoscope. 2003;113(6):1076-9. http://dx.doi. org/10.1097/00005537-200306000-00030. PMid:12782826.

16. Rodríguez-Cuevas S, Labastida S, Gutierrez F, Granados F. Oral feeding after total laryngectomy for endolaryngeal cancer. Eur Arch Otorhinolaryngol. 1995;252(3):130-2. PMid:7662344.

17. Timmermans AJ, Lansaat L, Kroon GVJ, Hamming-Vrieze O, Hilgers FJM, van den Brekel MWM. Early oral intake after total laryngectomy does not increase pharyngocutaneous fistulization. Eur Arch Otorhinolaryngol. 2014;271(2):353-8. PMid:23625389.

18. Aswani J, Thandar M, Otiti J, Fagan J. Early oral feeding following total laryngectomy. J Laryngol Otol. 2009;123(3):333-8. PMid:18501033.

19. Benali J, Viljoen G, Ayad T, Gravier-Dumonceau R, Ceccon FP, Tangjaturonrasme N, Saibene AM, Chiesa-Estomba C, Melkane AE, Allen J, Lim CM, Mayo-Yañez M, Tucciarone M, Sargi Z, Mouawad F, Ramirez AT, Magaró M, Michel J, Radulesco T, Giovanni A, Fagan JJ, Hao SP, Lechien JR, Giorgi R, Fakhry N. Management of oral feeding following total laryngectomy around the world: YO-IFOS international study. Head Neck. 2022;44(8):1755-64. PMid:35266210.

20. Süslü N, Hoşal AŞ. Early oral feeding after total laryngectomy: outcome of 602 patients in one cancer center. Auris Nasus Larynx. 2016;43(5):546-50. http:// PMid:26908188.

21. Bulğurcu S, Çukurova İ. Comparison of early versus delayed oral feeding after total laryngectomy in terms of pharyngocutaneous fistula development. Turk Arch Otorhinolaryngol. 2018;56(4):217-20. PMid:30701117.

22. Prasad KC, Sreedharan S, Dannana NK, Prasad SC, Chandra S. Early oral feeds in laryngectomized patients. Ann Otol Rhinol Laryngol. 2006;115(6):433-8. http:// PMid:16805374.

23. Sousa AA, Porcaro-Salles JM, Soares JMA, Meyer de Moraes G, Souza Silva G, Abreu Sepulcri R, Rezende Carvalho J, Savassi-Rocha PR. Tolerance of early oral feeding in patients subjected to total laryngectomy. Head Neck. 2016;38(S1, Suppl 1):E643-8.

24. Le Flem M, Santini L, Boulze C, Alshukry A, Giovanni A, Dessi P, Fakhry N. Early oral hydration protects against pharyngocutaneous fistula after total laryngectomy or total pharyngolaryngectomy. Head Neck. 2020;42(8):1902-6. http://dx.doi. org/10.1002/hed.26122. PMid:32125034.

25. Arenaz Búa B, Pendleton H, Westin U, Rydell R. Voice and swallowing after total laryngectomy. Acta Otolaryngol. 2018;138(2):170-4. 00016489.2017.1384056. PMid:28978261.

26. Milinis K, Gaskell P, Lau A, Lancaster J, Jones T. Early versus late oral feeding following total (pharyngo) laryngectomy: systematic review and meta‐analysis. Head Neck. 2021;43(4):1359-68. PMid:33543554.

27. Aires FT, Dedivitis RA, Petrarolha SMP, Bernardo WM, Cernea CR, Brandao LG. Early oral feeding after total laryngectomy: a systematic review. Head Neck. 2015;37(10):1532-5. PMid:24816775.

28. Singh R, Karantanis W, Fadhil M, Dow C, Fuzi J, Robinson R, Jacobson I. Metaanalysis on the rate of pharyngocutaneous fistula in early oral feeding in laryngectomy patients. Am J Otolaryngol. 2021;42(1):102748. http://dx.doi. org/10.1016/j.amjoto.2020.102748. PMid:33068955.

29. Boyce SE, Meyers AD. Oral feeding after total laryngectomy. Head Neck. 1989;11(3):269-73. PMid:2498231.

30. Fagan JJ. Early oral feeding following primary total laryngectomy. In: Gooi Z, Agrawal N, editors. Difficult decisions in head and neck oncologic surgery. Cham: Springer; 2019. p. 107–11.

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