Meta-analysis on the safety and efficacy of early oral feeding after total laryngectomy.

Purpose: To evaluate the safety and efficacy of early oral feeding (≤ 3 days) and delayed oral feeding (≥ 7 days) following total laryngectomy.

Methods: Relevant literatures on early and delayed oral feeding following total laryngectomy published before January, 2019 were searched in PubMed, EMBASE, Web of Science, Cochrane Library, CNKI and Wanfang Database. Two reviewers were responsible for selecting literatures, extracting data and cross-check. The incidence of pharyngocutaneous fistula (PCF) was evaluated by calculating OR and 95%CI. Difference in length of stay (LOS) of patients undergoing early oral feeding or delayed oral feeding was compared using standardized mean difference (SMD) and 95%CI. Sensitivity analysis and publication bias examination were conducted.

Results: 14 eligible literatures were enrolled, including 1824 patients who underwent total laryngectomy, with 1250 cases of early oral feeding and 574 cases of delayed oral feeding. The incidence of PCF was similar in patients receiving early oral feeding or delayed oral feeding following total laryngectomy (OR=1.12, 95%CI=0.81-1.54). LOS was shorter in cases of early oral feeding than those of delayed oral feeding (SMD=-0.77, 95%CI=-1.18-0.36). Reliable conclusions were obtained without obvious publication bias.

Conclusions: Early oral feeding following total laryngectomy shortens LOS relative to delayed oral feeding. No significant difference in the incidence of PCF is observed between early oral feeding and delayed oral feeding, suggesting that early oral feeding following total laryngectomy is safe and efficacious.