Gastrostomy Tubes in Patients with Advanced Head and Neck Cancer

Ahmed, Khwaja Asif; Samant, Sandeep; Vieira, Francisco

doi:10.1097/01.mlg.0000150679.60731.bc

Cited by 38 publications

(30 citation statements)

References 11 publications

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“…3,4,15 Our findings were concordant with these studies except that we did not find a significant relationship between hypopharyngeal tumors and G-tube placement, presumably because most surgeries for hypopharyngeal cancer involve a laryngopharyngectomy, which rarely results in swallowing dysfunction. We also found that larger tumors (ie, T3-T4) were more likely to require postoperative G-tubes, which is intuitive, given the greater volume of tissue excised with larger tumors and the need for larger and potentially more bulky reconstructions.…”

Section: Discussionsupporting

confidence: 89%

A Model for Predicting Gastrostomy Tube Placement in Patients Undergoing Surgery for Upper Aerodigestive Tract Lesions

Mays

Moustafa

Worley

et al. 2014

JAMA Otolaryngol Head Neck Surg

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IMPORTANCE Identifying high-risk patients in the preoperative period can allow physicians to optimize nutritional status early for better outcomes after head and neck cancer resections. OBJECTIVE To develop a model to predict preoperatively the need for gastrostomy tube (G-tube) placement in patients undergoing surgery of the upper aerodigestive tract. DESIGN, SETTING, AND PARTICIPANTS This retrospective medical record review included all adult patients diagnosed with head and neck cancers who underwent tumor resection from 2007 through 2012 at Wake Forest Baptist Health, a level 1 tertiary care center. Records were screened for patient demographics, tumor characteristics, surgical treatment type, and postoperative placement of G-tube. A total of 743 patients underwent resection of head and neck tumors. Of these, 203 were excluded for prior G-tube placement, prior head and neck resection, G-tube placement for chemoradiotherapy, and resection for solely nodal disease, leaving 540 patients for analysis. MAIN OUTCOMES AND MEASURES Placement of postoperative G-tube. RESULTS Of the 540 included patients, 23% required G-tube placement. The following variables were significant and independent predictors of G-tube placement: preoperative irradiation (odds ratio [OR], 4.1; 95% CI, 2.4–6.9; P < .001), supracricoid laryngectomy (OR, 26.0; 95% CI, 4.9–142.9; P < .001), tracheostomy tube placement (OR, 2.6; 95% CI, 1.5–4.4; P < .001), clinical node stage N0 vs N2 (OR, 2.4; 95% CI, 1.4–4.2; P = .01), clinical node stage N1 vs N2 (OR, 1.6; 95% CI, 0.8–3.3; P = .01), preoperative weight loss (OR, 2.0; 95% CI, 1.2–3.2; P = .004), dysphagia (OR, 2.0; 95% CI, 1.2–3.2; P = .005), reconstruction type (OR, 1.9; 95% CI, 1.1–2.9; P = .02), and tumor stage (OR, 1.8; 95% CI, 1.1–2.9; P = .03). A predictive model was developed based on these variables. In the validation analysis, we found that the average predicted score for patients who received G-tubes was statistically different than the score for the patients who did not receive G-tubes (P = .01). CONCLUSIONS AND RELEVANCE We present a validated and comprehensive model for preoperatively predicting the need for G-tube placement in patients undergoing surgery of the upper aerodigestive tract. Early enteral access in high-risk patients may prevent complications in postoperative healing and improve overall outcomes, including quality of life.

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Section: Discussionsupporting

confidence: 89%

A Model for Predicting Gastrostomy Tube Placement in Patients Undergoing Surgery for Upper Aerodigestive Tract Lesions

Mays

Moustafa

Worley

et al. 2014

JAMA Otolaryngol Head Neck Surg

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“…Finding dose/volume predictors of PEG insertion during treatment may help to identify the subgroup of patients in whom the benefits of supportive care and nutritional support intervention are maximized when delivered in a timely fashion (12,13). Moreover, for the majority of patients who will not need a PEG tube during treatment, their application has the potential to reduce the incidence and the severity of both acute and consequential late side effects, such as longterm dysphagia (11).…”

Section: Discussionmentioning

confidence: 99%

“…Another concern would be the potential for enhanced risk of atrophy of the masticatory and swallowing muscles, resulting in long-term feeding tube dependence (11). Therefore, timely identification of the subgroup of patients who will require a PEG tube during treatment is critical to maximize its benefits (12,13).…”

Section: Introductionmentioning

confidence: 99%

Weekly Dose–Volume Parameters of Mucosa and Constrictor Muscles Predict the Use of Percutaneous Endoscopic Gastrostomy During Exclusive Intensity-Modulated Radiotherapy for Oropharyngeal Cancer

Sanguineti

Gunn

Parker

et al. 2011

International Journal of Radiation Oncology*Biology*Physics

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“…Patients with advanced neoplasm of the head and neck require special attention, because they present significant deterioration of their quality of life, mainly owing to the location of these tumors, which, when invasive, can affect the swallowing function, with direct consequences on the nutritional status and survival of these individuals (11) . However, the difficulty in maintaining adequate ingestion of nutrition is a consequence not only of the neoplasm but also of the treatment used, which varies from extensive resection of the oropharynx to chemotherapy and radiotherapy.…”

Section: Indicationsmentioning

confidence: 99%

Computed tomography-guided percutaneous gastrostomy: initial experience at a cancer center

et al. 2017

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Gastrostomy is indicated for patients with conditions that do not allow adequate oral nutrition. To reduce the morbidity and costs associated with the procedure, there is a trend toward the use of percutaneous gastrostomy, guided by endoscopy, fluoroscopy, or, most recently, computed tomography. The purpose of this paper was to review the computed tomography-guided gastrostomy procedure, as well as the indications for its use and the potential complications.

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Gastrostomy Tubes in Patients with Advanced Head and Neck Cancer

Cited by 38 publications

References 11 publications

A Model for Predicting Gastrostomy Tube Placement in Patients Undergoing Surgery for Upper Aerodigestive Tract Lesions

A Model for Predicting Gastrostomy Tube Placement in Patients Undergoing Surgery for Upper Aerodigestive Tract Lesions

Weekly Dose–Volume Parameters of Mucosa and Constrictor Muscles Predict the Use of Percutaneous Endoscopic Gastrostomy During Exclusive Intensity-Modulated Radiotherapy for Oropharyngeal Cancer

Computed tomography-guided percutaneous gastrostomy: initial experience at a cancer center

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