Objectives. To assess the effects of early oral feeding in laryngectomy patients versus delayed oral feeding. The outcomes used are mortality, pharyngocutaneous fistula rate, quality of life, hospital length of stay, and complications. Method. We performed searches within five major databases until June 2013. We considered randomised control trials (RCTs) and included nonrandomised studies for the assessment of harms. Results. We included four RCTs for assessment of benefits and three nonrandomised studies for assessment of harms (393 participants). There was no statistically significant difference detected in mortality at six months, pharyngocutaneous fistulae, or complications. The length of hospital stay was shorter in the early feeding group, MD ？2.72 days [95% CI ？5.34 to ？0.09]. Conclusion. Early oral feeding appears to have similar incidence of complications and has the potential to shorten the length of hospital stay. Further well-designed RCTs are necessary because of weakness in the available evidence. 1. Introduction Total laryngectomy is widely performed across the world [1]. Despite changes in treatment protocols over the last twenty years following the radiation therapy oncology group (RTOG) [2] and Veterans Affairs [3] studies towards organ preserving protocols in laryngeal carcinoma, total laryngectomy continues to be an important treatment option. Heath episode statistics (HES) data from England in 2011-2012 suggests that up to 600 laryngectomies are being performed per year in the UK [4] and 3414 per year in USA [5]. Squamous cell carcinoma of the larynx or hypopharynx is the underlying pathology in over 95% of people undergoing total laryngectomies [6], with the other main indication being life threatening laryngeal dysfunction with aspiration seen in certain neurological conditions [7]. The aims of total laryngectomy are to provide a safe airway after the removal of larynx and establish enteral continuity allowing for oral feeding. The main choice is starting oral feeding between at an early stage and at a delayed or late stage. Typically most patients wait a minimum of 7 days following total laryngectomy before oral feeding is started. 84% of 141 American surgeons reported [8] that they waited until after the seventh postoperative day in a questionnaire survey by Boyce and Meyers in 1989. However periods of up to three weeks were reported. The choice often depends on the surgeon’s experience and preference and on the patient’s comorbidities and the tumor characteristics [9]. The reason for late feeding has been argued that
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