Postlaryngectomy care, recovery and rehabiliation aspects

In de laatste 30 jaar is het behandellandschap voor patiënten met een vergevorderd stadium (T3 en T4) larynxcarcinoom (strottenhoofdkanker) of hypofarynxcarcinoom (onderste keelholtekanker) ingrijpend veranderd; het gebruik van orgaansparende behandelingen (chemo)radiotherapie ((C)RT) is toegenomen en het toepassen van primaire chirurgie (totale laryngectomie; TL) is afgenomen. Temeer daar TL vaker als laatste redmiddel moet worden ingezet na voorgaande (C)RT, is het ook belangrijk om, naast aandacht voor functionele en oncologische uitkomsten, de postoperatieve zorg en het postoperatief herstel en revalidatie na een TL te blijven monitoren in dit veranderde behandellandschap. Dit proefschrift beschrijft en bediscussieert deze onderwerpen, zowel op instituuts- als op nationaal niveau

Early oral intake after total laryngectomy does not increase pharyngocutaneous fistulization

Timing of oral intake after total laryngectomy (TLE) is mostly delayed until postoperative day 10-12, under the assumption that this limits the incidence of pharyngocutaneous fistulization (PCF). However, early oral intake could be advantageous and could reduce costs, providing that it does not lead to increased PCF. Comparison of PCF incidence in traditional ‘late’ oral intake protocol (start at postoperative day 10-12; LOI) and in early oral intake protocol (start at postoperative day 2-4; EOI). Retrospective cohort study comparing two different oral intake protocols in 247 consecutive patients laryngectomized between early 2000 until mid 2006 (LOI; N = 140), and mid 2006 until mid 2012 (EOI; N = 107). Both groups were comparable in terms of sex, age, origin of tumor, and TLE indication, except for the American Society of Anesthesiologists score (ASA), which was slightly more favorable in the LOI group (p = 0.047). Compliance with the oral intake protocols during both periods was good: the median day of starting oral intake was day 11 (range 6-103) in the LOI group vs. day 3 (range 2-84) in the EOI group (p = 0.001). The incidence of PCF was not significantly different between the two groups (25 % for LOI and 32 % for EOI; Fisher’s exact: p = 0.255). In addition, no association was observed between the timing of oral intake and PCF (HR = 0.995; CI 0.98-1.01; p = 0.364). This study suggests that early oral intake is safe and does not increase pharyngocutaneous fistulization