Patients with head and neck cancer are at increased risk of malnutrition. There is much debate about the optimal method of feeding. A comprehensive literature review was conducted to compare the effectiveness of prophylactic gastrostomy versus no prophylactic gastrostomy in patients with head and neck cancer for the outcomes of treatment interruptions, unplanned admissions and weight changes, due to nutritional reasons. Ten articles were included in the review, including one randomised controlled trial, two cohort and seven case-controlled studies. Meta-analysis showed prophylactic gastrostomy significantly decreased unplanned admissions (P<0.0001). No statistical significance was shown for the treatment interruptions outcome (P=0.11). There was less percentage weight loss in the prophylactic gastrostomy group but statistical comparison was not applicable. Prophylactic gastrostomy decreases the number of unplanned admissions and may reduce weight loss. There is insufficient evidence to change practice but new knowledge is provided in the field.