***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: OBJECTIVES To determine whether , in a developing world context , early oral feeding after laryngectomy is safe , cost-effective and appropriate . STUDY DESIGN A prospect i ve study of early oral feeding after laryngectomy , compared with retrospective , historical delayed feeding controls . METHOD Forty patients underwent total laryngectomy for advanced carcinoma of the larynx with or without hypopharyngeal involvement , not requiring tongue base resection or myocutaneous flaps , and were commenced on oral feeding on the second post-operative day . Thirty-nine laryngectomy patients previously managed in the same unit who had received conventional , delayed oral feeding  served as controls . RESULTS Pharyngocutaneous fistulae developed in 20 per cent of the early feeding patients , compared with 15.4 per cent of the delayed oral feeding controls ( p = 0.592 ) . For patients who did not develop fistulae , hospitalisation was shorter in the early oral feeding group ( p = 0.007 ) . CONCLUSION Early oral feeding for laryngectomy patients is recommended , both in developed and developing countries Pharyngocutaneous ( PC ) fistula is a common complication following  laryngectomy .  It leads to increased morbidity , delay in adjuvant treatment , prolonged hospitalization and an increase in treatment costs . Although a number of factors that result in PC fistula have been described , there is still no agreement on the most significant factors . We undertook a prospect i ve study to critically analyze PC fistula and its association with various tumors , patient and treatment related factors . This was a prospect i ve study that included 143 patients who underwent laryngeal surgery for squamous cell carcinoma of the larynx and pyriform sinus . Use of pectoralis major myocutaneous flap to reconstruct the neopharynx , primary disease in pyriform and extensive soft tissue infiltration were significantly associated with PC fistula . Prior treatment ( radiotherapy and chemotherapy ) , type of closure ( T closure , Y closure and vertical closure ) , Layers of closure ( full thickness interrupted , submucosal interrupted , submucosal continuous ) type of suture material ( silk , vicryl ) , age , sex , stage , preoperative tracheostomy , cut margin status , pre/postoperative hemoglobin and experience of surgeons did not relate significantly BACKGROUND AND OBJECTIVE A pharyngocutaneous fistula is the most common complication after total laryngectomy . In Germany , a traditional recommendation is to use a nasogastric tube for feeding for 10 - 14 days postoperatively because many surgeons believe that oral feeding after surgery contributes to fistula development . However , there is no international agreement about when to begin oral feeding after total laryngectomy . Some authors begin oral feeding between the 1st and 4th postoperative day without any nasogastric tube , while others using a nasogastric tube delay oral feedings until 7 - 14 days after surgery . The aim of the present study was to investigate the relationship between the timing of oral feeding and the development of fistulas after total laryngectomy . PATIENTS / METHODS In a prospect i ve trial with 42 consecutive patients who underwent laryngectomy , oral feeding was started on different postoperative days between the 1st and the 10th . Most patients were selected r and omly for the different postoperative days . Furthermore , other potential risk factors predisposing to fistula formation were analyzed retrospectively . RESULTS Five fistulas occurred in the total group ( 12 % ) . Early postoperative oral feeding does not increase the incidence of fistulas . The fistula rate was only 9 % in patients fed orally in the 1st postoperative week . The analysis of further risk factors for fistula formation showed only a significant correlation between type of resection and fistula occurrence ( extended laryngectomy with partial pharyngectomy vs st and ard laryngectomy ; p = 0.018 ) . CONCLUSIONS Our results indicate that early oral feeding in the 1st postoperative week does not influence fistula formation after laryngectomy OBJECTIVE To evaluate the safety and efficacy of early oral feeding by comparing it with feeding through primary tracheoesophageal puncture after total laryngectomy with primary pharyngeal closure . STUDY DESIGN A prospect i ve , r and omized , controlled study . METHODS Patients who underwent total laryngectomy with primary pharyngeal closure and who were c and i date s for primary voice restoration ( an in whose cases primary tracheoesophageal puncture [ TEP ] was created ) were included . After total laryngectomy , patients were r and omly assigned to either the oral group ( study group ) or the TEP group ( control group ) . Patients in the oral group were fed orally with a clear liquid diet on the first postoperative day , then advanced to a regular diet , whereas patients in the TEP group were fed through tracheoesophageal puncture and received nothing orally until the seventh postoperative day ; then they were fed orally if fistula had not occurred . St and ard criteria for discharge were used for all the patients . RESULTS During a 3-year period , 67 patients were enrolled in the trial , and complete data were available for 65 patients ( 32 patients in the oral group , 33 patients in the TEP group ) . The two groups were similar for factors reported to influence the rate of pharyngocutaneous fistula . In three ( 9 % ) patients in the TEP group , fistula occurred on the 5th , 7th , and 14th postoperative days , respectively . Two ( 6.2 % ) fistulas occurred in the oral group on the sixth and eighth postoperative days , respectively . In patients without fistula , the mean length of hospital stay was 7.6 days ( range , 4 - 19 d [ SD = 3.1 d ] ) for the oral group and 8.2 days ( range , 7 - 18 d [ SD = 2.6 d ) for the TEP group . There was no significant difference between two groups for either the incidence of fistula or the length of hospital stay . CONCLUSIONS Initiation of oral feeding on the first postoperative day in patients undergoing total laryngectomy with primary pharyngeal closure is a safe clinical practice . However , it does not shorten the length of hospital stay for these patients OBJECTIVE To demonstrate the feasibility of oral feeding 48 - 72 hours after total laryngectomy of carcinoma of the larynx or pyriform sinus . METHOD Forty-two patients underwent total laryngectomy ( included 34 patients of larynx carcinoma and 8 patients of pyriform sinus carcinoma ) were r and om categorized into control group and experimental group . The experimental group of 21 patients who received oral feeding 48 to 72 h after total laryngectomy was compared with the control group of 21 patients who received oral feeding 10 to 12 days . RESULT Pharyngocutaneous fistula occurred in one patient ( 4.8 % ) in the experimental group and in two patients ( 9.5 % ) in the control group . These differences were not statistically significant ( P > 0.05 ) . The length of hospital stay was significantly shorted . CONCLUSION Our results indicate that in the patient population initiation of oral feeding 48 to 72 h after total laryngectomy of carcinoma of the larynx or pyriform sinus is a safe clinical practice Objectives : It is a common practice to start oral feeding after 7 to 10 days in patients who have undergone laryngeal surgeries . It was our observation that when oral feeds were initiated earlier than this period , there was no increase in the incidence of pharyngocutaneous fistulas . This prospect i ve study is about our experience in initiating early oral feeds in the postoperative period ( on the 2nd day ) in laryngectomized patients . Methods : Seventy-eight patients underwent laryngectomy with or without partial pharyngectomy over a period of 38 months between October 2001 and December 2004 . The oral feeds were initiated on the 2nd postoperative day in 40 patients . Thirty-eight patients served as controls in whom feeds were initiated after the 10th postoperative day . Results : Only 1 patient in the study group and 2 patients in the control group developed pharyngocutaneous fistulas . Most patients in the control group wished to avoid nasogastric intubation in the recovery period because of discomfort , gastric symptoms , and the need to taste food . Conclusions : With this study we can assume that in a select group of patients , it is possible to initiate oral feeding much earlier in the postoperative period than was formerly thought INTRODUCTION Pharyngocutaneous fistula is one of the most common nonfatal laryngectomy complications ( 7.6 % to 65 % of all total patients ) . Preoperative radiotherapy , advanced tumor stage , poor preoperative medical status , and concomitant pharyngectomy are usually accepted causative factors in fistula formation . Delay of oral feeding is a common practice used by head and neck surgeons to prevent the development of pharyngocutaneous fistula . In this article we analyze our experience with special emphasis given to the early start of postoperative feeding . PATIENTS AND METHODS The postoperative records of 48 patients who had undergone total laryngectomy or total laryngopharyngectomy were review ed . All patients were orally fed with water and clear liquids on the first postoperative day . The patients were closely observed at every feeding attempt , and if any sign of fistula was noted , a nasogastric tube was inserted . Preoperative radiotherapy , stage of disease , tumor differentiation , and pharyngectomy with total laryngectomy were statistically analyzed as potential risk factors contributing to fistula formation . The Fisher exact test was used to analyze the data . RESULTS The overall pharyngocutaneous fistula rate was 12.5 % in our series . The only statistically significant factor that increased the rate of fistula formation was resection of pharyngeal mucosa as an extension of total laryngectomy . Other parameters failed to show any statistical significance in development of this complication . CONCLUSION Evaluation of fistula incidence in our series indicates that initiating oral feeding on the first postoperative day does not contribute to fistula formation . Additionally , the relatively shortened hospital stay and elimination of the psychologic and traumatic side effects of tube feeding are benefits of this approach that should be studied in further prospect i ve quality -of-life studies 
    Output:
    
There is no increase in pharyngocutaneous fistula rates in patients who receive early oral feeding after total laryngectomy