Oral feeding commencement following free or pedicle flap reconstruction for oral cancer: Experience from a tertiary referral centre

Abstract

Head and neck cancer (HNC) resections may include free or pedicle flap reconstruction. Post-operative feeding practices vary and many centres adopt a conservative approach of 6–12 days ‘nil by mouth’ period to allow surgical healing and avoid complications. Recent studies have assessed the safety of early oral feeding, but literature on free flaps is limited. Aim of this study was to examine oral feeding practices in HNC post flap reconstructions. A retrospective consecutive case-series in a tertiary, centralised London centre. Data was collected on demographics (age, gender, tumour site/stage), tracheostomy, type of flap, complications, post-operative days of oral diet initiation and enteral feeding, and length of stay (LOS). Exclusion criteria included previous radiotherapy, ear/nose/throat or non-SCC tumours or lack of reconstructive surgery. 35 patients were included (n = 19 male (54.3%) n = 16 female (45.7%) with a mean age of 61.2 years. 68.6% (n = 24) underwent a free flap and 31.4% (n = 11) pedicle flap. Oral diet initiation was a mean of 11.9 days. Post-operative LOS was a median of 15 days ranging from 3-44 days. Linear regression indicated a weak positive correlation between post-operative oral diet initiation and LOS (R 2 = 0.2937) and between post-operative length of enteral feeding and LOS (R 2 = 0.4542). Traditional approaches for post-operative feeding practices existed in this centre. Weak relationship was observed between earlier commencement of oral diet and shorter LOS. Further research is required to establish a causal relationship between safe early feeding, early discharge and qualitative studies investigating attitudes for early feeding. • Post-operative feeding practices following free flap surgery for head and neck cancer (HNC) vary. • No nationally agreed recommendations exist on when to initiate oral diet post operatively in HNC. • Early oral feeding is gaining momentum as part of enhanced recovery protocols but is not well defined. • A weak relationship was observed between earlier commencement of oral diet and shorter LOS. • Further research is required to establish the efficacy of safe early oral feeding.