Q17. When or how should post operative tube feeding commence?
There are no specific studies relating to the timing of commencing post operative tube feeding in patients with head and neck cancer, and so refer to the European Society of Parenteral and Enteral Nutrition (ESPEN) Guidelines on Enteral Nutrition: Surgery Including Organ Transplantation . In the literature specific to the head and neck cancer population, there is one level II neutral quality study  which examined overnight versus continuous feeding. Whilst overnight feeding was deemed to be more energy efficient, it demonstrated poorer nitrogen balance.
One level III-2 neutral quality study  compared method of tube feeding (gravity versus bolus versus pump) on the impact of gastrointestinal tolerance, and found no significant difference.
The remaining studies examined route of enteral feeding. One level III-2 neutral quality study  compared outcomes of enteral feeding via nasogastric versus gastrostomy tubes in post-operative patients and found that weight loss was significantly lower in the gastrostomy group, with fewer complications and higher patient acceptance and duration of nutritional support than in the nasogastric group. The final three studies are level IV (1 neutral quality, 2 negative quality) and look at pharyngostomy as a route of enteral feeding . This was traditionally used in the 1980’s prior to other technology, but has recently been addressed again in the literature in 2006 and 2008, however the complication rates are high, although minor e.g. oesophagitis, tube removal/dislodgement, tube migration.
|Post operative tube feeding should commence within 24 hours in patients in whom oral feeding cannot be established, with individual consideration to patients depending on surgical procedures in collaboration with the multidisciplinary team.||A|
- Weimann A, Braga M, Harsanyi L, Laviano A, Ljungqvist O, Soeters P, et al. ESPEN Guidelines on Enteral Nutrition: Surgery including organ transplantation. Clin Nutr 2006 Apr;25(2):224-44 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/16698152.
- Campbell IT, Morton RP, Macdonald IA, Judd S, Shapiro L, Stell PM. Comparison of the metabolic effects of continuous postoperative enteral feeding and feeding at night only. Am J Clin Nutr 1990 Dec;52(6):1107-12 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/2122715.
- Pesola GE, Hogg JE, Yonnios T, McConnell RE, Carlon GC. Isotonic nasogastric tube feedings: do they cause diarrhea? Crit Care Med 1989 Nov;17(11):1151-5 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/2507225.
- Sobani ZU, Ghaffar S, Ahmed BN. Comparison of outcomes of enteral feeding via nasogastric versus gastrostomy tubes in post operative patients with a principle diagnosis of squamous cell carcinoma of the oral cavity. J Pak Med Assoc 2011 Oct;61(10):1042-5 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/22356051.
- Patil PM, Warad NM, Patil RN, Kotrashetti SM. Cervical pharyngostomy: an alternative approach to enteral feeding. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006 Dec;102(6):736-40 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/17138174.
- Kent MS, Awais O, Schuchert MJ, Adusumilli PS, Keeley S, Alvelo-Rivera M, et al. Cervical pharyngostomy: an old technique revisited. Ann Surg 2008 Aug;248(2):199-204 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/18650628.
- John DG, Fielder CP. The feeding pharyngostomy: an alternative approach to enteral feeding. J Laryngol Otol 1991 Jun;105(6):451-3 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/1906520.