Guideline for prophylactic feeding tube insertion in patients undergoing resection of head and neck cancers

Background: Supplementary nutrition is an important aspect of the multidisciplinary management of head and neck cancer patients. In our unit, method of feeding is based on an arbitrary predicted duration of overall treatment (<30 days indicates NG feeding, >30 days prophylactic PEG tube insertion is appropriate). This paper provides a guideline to assist in choosing the feeding method early on to avoid the need for later PEG insertion in those who were initially fed orally or via NG tube. Patients and methods: 59 patients undergoing resection of head and neck tumours were included, grouped according to their tumour stage and location. They were assessed pre- and post-operatively for 5 years and their diet consistency score, method of supplementary feeding and weight were noted. Results: Mean prophylactic PEG feeding duration was 771 days (N = 12), these patients mostly had T3/T4 tumours involving the tongue. Mean NG duration was 30.5 days (N = 42), 15 later had PEG insertion at mean 47 days post-operatively, resulting in a total mean supplementary feeding duration of 579.6 days. These patients tended to have higher stage tumours and poorer pre-operative diet consistency scores. 43 patients required post-operative radiotherapy. This significantly increased feeding duration versus surgery alone, and therefore increases the likelihood of requiring PEG insertion. Conclusions: Based on our findings, we have constructed an algorithm to assist in determining which patients with operable head and neck cancer should have prophylactic PEG tube insertion. (C) 2011 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.