Timing of Oral Feeding in Patients Who have Undergone Free Flap Reconstruction for Oral Cancer

Objective: Determine the safety and effectiveness of a nasogastric tube removal plan designed to shorten nasogastric tube indwelling time after oral cancer surgery plus free flap reconstruction.

Materials and methods: A parallel randomized clinical trial was conducted from May 2021 to December 2021 at Peking University School of Stomatology. Volunteers (n = 128) were separated into four groups: non-tracheostomy control and intervention groups and tracheostomy control and intervention groups. Control patients received the conventional nasogastric tube removal plan. Non-tracheotomy intervention patients were asked to swallow 5 ml of water on the first postoperative day. If there was no coughing, they were allowed progressively increasing amounts of water for the following 2 days. The nasogastric tube was removed only after ensuring level I/II performance on the Watian water swallowing test, no "wet voice" after drinking water, no marked decrease in blood oxygen saturation after drinking, and satisfactory daily oral nutritional intake. Tracheotomy intervention patients received the same protocol plus an additional Watian water swallowing test after tracheal tube removal.

Results: Nasogastric tube removal time was earlier in the intervention subgroups than in control subgroups: 5.0 ± 2.3 days versus 7.8 ± 3.9 days (p = 0.001) in non-tracheostomy patients and 9.8 ± 1.1 days versus 16.2 ± 13.0 days (p = 0.049) in tracheostomy patients. Incidence of wound complications and daily food intake were comparable between the groups. The incidence of pneumonia was lower in the tracheostomy intervention group than in the tracheostomy control group (12.5% vs. 3.1%, p = 0.162). Pharyngeal pain score was lower in tracheotomy intervention patients than in tracheotomy control patients (p = 0.029). Postoperative hospital stay was shorter in tracheotomy intervention patients than in tracheotomy control patients (p = 0.005).

Conclusions: On the basis of ensuring safety and effectiveness, patients undergone free flap reconstruction for oral cancer could be offered oral intake early after surgery, which will not increase the incidence of wound complications and pneumonia or adversely affecting the oral intake of the patients; it can also help minimize pharyngeal pain and shorten postoperative hospital stay of patients with a tracheotomy.

Level of evidence: 2 Laryngoscope, 133:1382-1387, 2023.