Postoperative feeding practices and nutritional intake in patients with head and neck cancer undergoing surgery with flap tissue transfer reconstruction: a scoping review

Surgery with flap reconstruction is commonly utilised in the treatment of head and neck cancer (HNC). Following surgery, patients are made nil-by-mouth (NBM) and receive enteral tube feeding until they can recommence oral intake. Recent reviews have focussed on whether ‘early oral feeding’ (EOF) as part of enhanced recovery after surgery is beneficial. Limited literature has focussed on how patients are transitioned from tube to oral intake and nutritional implications. This review aims to map the evidence on postoperative feeding practices and nutritional intake of patients with HNC undergoing flap surgery. Titles, abstracts and subsequent full-text articles were screened from six databases: Embase, Medline, Scopus, Cochrane, CINAHL, Web of Science and grey literature by two independent researchers who both extracted data. A third reviewer was consulted when required. Inclusion criteria: all articles reporting on postoperative feeding practices in HNC flap surgery (RCTs, observational studies, case reports/series, guidelines). Findings were synthesised and presented using a narrative description approach. After searching 5093 citations and 405 full-texts, 36 articles were included. Enteral feeding tubes were either intraoperative nasogastric tube or gastrostomy pre-, intra- or postoperatively with feeds ideally commencing within 24 h of surgery. Gastrostomy placement was informed by disease, treatment and socio-demographic factors including age, tumour stage/site, prior/adjuvant radiotherapy and surgery extent. The timing/type to oral feeding was mainly surgeon-led ± speech and language therapy (SLT) and varied from postoperative day 1 (sterile water ± fluids ± smooth puree ± solid/semi-solid diet) to postoperative day 20 (fluids progressing to soft diet). EOF was defined as ≤5days and delayed/traditional feeding as >5days or after a 6–12 day nil-by-mouth period. Nutritional adequacy was mainly assessed by dietitians or nurses and thresholds varied between 60 and 100% of estimated nutritional requirements. Postoperative feeding practices in HNC flap surgery vary and are associated with unit culture and clinician preference. Further prospective studies are required to identify factors associated with optimal timing and adequacy of oral feeding and exploration of clinician perceptions/practices.