Early Feeding After Free-Flap Reconstruction for Oral Cavity Cancer

Introduction: Patients undergoing free flap reconstruction of the oral cavity have traditionally received nothing by mouth for 1-2 weeks postoperatively to limit the risk of wound complications. Growing evidence suggests that earlier initiation of oral intake may not increase morbidity. This study further investigates the utility of “early feeding.”

Methods: This retrospective cohort study included subjects who underwent free flap surgery for oral cavity cancer from June 2020-October 2022 at a large, urban tertiary healthcare system. Based on surgeon preferences and practices, patients had been fed by mouth at varying times postoperatively. This cohort was grouped into early feeding (oral intake on or before postoperative day five) and late feeding (oral intake after postoperative day five). The primary outcome of interest was rate of orocutaneous fistula. Secondary outcomes included development of other local complications (wound dehiscence, microvascular complication, hematoma), systemic complications (pneumonia, sepsis), and length of hospital stay (LOS).

Results: 66 patients were studied, with 26 belonging to the late-feeding (LF) group and 40 to the early-feeding (EF) group. No differences existed between groups in terms of gender, BMI, or preoperative chemo- or radiotherapy. However, the LF group was significantly more likely to have defects extending beyond the oral cavity (50.0% vs. 25.0%, p = .037) and were older (median age 80 vs. 64.5 years, p = .027). No significant differences were found in orocutaneous fistula formation between the LF and EF groups (7.7% vs. 0%, p = .152), but the rate of total complications was significantly higher in the LF group (38.5% vs. 12.5%, p = .014). LOS was significantly longer in the LF group, with a median LOS of 12.5 days compared to 6 days in the EF group (p < .001).

Conclusions: These findings suggest that in a correctly selected patient population, early postoperative oral intake facilitates earlier hospital discharge without increasing the risk of postoperative complications. Prospective clinical trials with larger sample sizes are needed to further support these findings.