A review of post-operative feeding in patients undergoing resection and reconstruction for oral malignancy and presentation of a pre-operative scoring system.

Percutaneous endoscopic gastrostomy (PEG) and nasogastric tubes (NGT) are routine after resection and reconstruction of oral cancer. The selection of the most appropriate method of feeding can be challenging, as both methods carry morbidity. This makes correct selection paramount. The objectives of this retrospective review were to identify the benefits and complications of feeding with PEG and NGT in patients with oral malignancy. We retrospectively reviewed 144 patients who had undergone oral cancer resection and reconstruction, to compare PEG and NGT feeding and to identify the key factors that aid selection of the most appropriate feeding method. We used these factors to develop the Key to Appropriate Replacement Enteral Nutrition (KAREN) scoring system. One hundred and twenty of the 144 patients were managed with PEG, and of these, 9 used it for less than 28 days. The mean (range) duration of use was 13 (5-63) days, and 1.9 (1-5) tubes/patient were used. The KAREN scoring system assigned the correct method of feeding in 92% of cases. The scoring system requires prospective validation but could provide clinicians with a tool to assist in a sometimes difficult decision.