Enhanced-recovery after surgery and early oral feeding for head and neck surgery cancer patients

摘要

Background: Enhanced Recovery After Surgery (ERAS) guidelines recommend pre-operative dietitian assessment and post-operative enteral nutrition (EN) within 24 hours, to reduce length of stay and post-operative complications after head and neck (H&N) cancer surgeries. Evidence supports safety of early oral intake, (<6 days post-opera-tively) after total-laryngectomy (TL). Aim: To investigate current nutrition care for patients undergoing H&N cancer surgery. Methods: Surgeries performed between January 2016 and June 2018 requiring post-operative EN were included. Retrospective chart audit and coding data from pre-operative outpatient presentation to post-operative discharge were collected. Surgical complications included wound dehis-cence, haematoma, and/or anastomotic leak. Results: Data for 147 patients were collected (76% male, median (IQR) age 65 (55.4-72.4) years, 41% current smokers and 55% stage 4 disease). Most (87%) had pre-operative dietitian assessment, 50% reported unintentional weight loss and 62% odynophagia. Surgeries were classified into subgroups: partial glossectomy (n = 33), floor of mouth (FOM) (n = 20), soft palate/oropharynx (n = 26), pharyngolaryngectomy (n = 23) and TL (n = 12). Proportion of patients commenced on EN within 24 hours post-operatively varied across surgeries; FOM (90%), TLs (83%) and pharyngolaryngectomys (35%). Commencement of oral intake was significantly delayed in patients with surgical complications (n = 31) compared to no complications (n = 103), 16.2 ± 9.7 vs 10.1 ± 5.9 days (P = 0.002). For TLs without surgical complications (n = 8), mean days to oral intake commencement was 11.4 ± 3.2. Conclusions: ERAS nutrition targets of pre-operative dietitian assessment and post-operative enteral nutrition (EN) within 24 hours are being met, but not consistently across all H&N subgroups. Multidisciplinary strategies to transition from EN to oral intake after TL are a key priority.