Incidence of abdominal wall metastases following percutaneous endoscopic gastrostomy placement in patients with head and neck cancer

Fung, Eleanor C.; Strosberg, David S.; Jones, Edward L.; Dettorre, Rebecca; Suzo, Andrew; Meara, Michael P.; Narula, Vimal K.; Hazey, Jeffrey W.

doi:10.1007/s00464-016-5394-8

Cited by 30 publications

(35 citation statements)

References 12 publications

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“…A recent study analysed 777 patients with HNC following PEG tube placement, detecting five cases of gastrostomy metastasis, with an overall incidence of 0.64%, all of them with PEG tube insertion via a pull method [9]. There are different theories of the pathogenesis of tumour spread to the gastrostomy site, this study supports the theory of direct inoculation of tumour cells at time of tube placement.…”

Section: Discussionsupporting

confidence: 65%

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Pain and Swelling after Percutaneous Endoscopic Gastrostomy Removal: An Unexpected Evolution

Queirós

Sousa

Antunes

et al. 2018

GE Port J Gastroenterol

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Gastrostomy site metastization is considered an uncommon complication of percutaneous endoscopic gastrostomy (PEG) placement in patients with head and neck tumours, but it is important to consider this possibility when evaluating gastrostomy-related symptoms. The authors present the case of a 40-year-old male with excessive alcohol consumption and active smoking, diagnosed with a stage IV oropharyngeal squamous cell carcinoma. The patient developed a paraneoplastic demyelinating motor polyneuropathy that, associated with tumour mass effect, caused dysphagia with need for nasogastric tube feeding. Treatment with radiotherapy and then chemoradiotherapy was administered and a PEG was placed with the pull method. Cancer remission and resolution of polyneuropathy was achieved, so PEG was removed. Two weeks later, the patient presented with pain and swelling at the gastrostomy site suggesting a local abscess, with improvement after drainage and antibiotic therapy. After 1 month, there was a tumour mass at the gastrostomy site and an oropharyngeal cancer metastasis was diagnosed. The patient underwent surgical excision of abdominal wall metastasis and abdominal disease was controlled. Nevertheless, there was subsequent oropharyngeal neoplasia recurrence and the patient died 6 months later. This case raises the discussion about gastrostomy placement methods that could avoid gastrostomy site metastization, the possible differential diagnosis, and diagnostic workout. Surgical resection may allow metastatic disease control, but by primary disease evolution greatly affects prognosis.

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Section: Discussionsupporting

confidence: 65%

“…When surgery is not an option, treatments like radiotherapy may be considered, allowing disease control [9]. …”

Section: Discussionmentioning

confidence: 99%

Pain and Swelling after Percutaneous Endoscopic Gastrostomy Removal: An Unexpected Evolution

Queirós

Sousa

Antunes

et al. 2018

GE Port J Gastroenterol

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“…The majority (82%) of cases were of head and neck cancer, the remainder oesophageal cancer. Histology (not reported in four cases) was squamous carcinoma in all but four cases (one each of carcinosarcoma of the cervical esophagus, oesophageal adenocarcinoma, pharyngeal adenocarcinoma, and tongue adenocarcinoma). In cases where the stage was clearly stated, 39 of 64 (61%) were T 4 and 52 of 63 (83%) were node‐positive.…”

Section: Resultsmentioning

confidence: 92%

“…Data from the randomized trial, the 27 retrospective and 2 prospective case series are summarized in Table .…”

Section: Resultsmentioning

confidence: 99%

Tumor implantation following percutaneous endoscopic gastrostomy insertion for head and neck and oesophageal cancer: Review of the literature

Rowell

2019

Head & Neck

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Background Because of publication bias, there is uncertainty about the true incidence of tumor seeding or implantation in patients with head and neck or oesophageal cancer undergoing percutaneous endoscopic gastrostomy (PEG) insertion. Methods In order to obtain a more reliable estimate of risk, a systematic review was undertaken. Randomized or non‐randomized studies and case reports were identified by electronic searching. A risk of bias assessment was carried out for each study. Results Ninety‐eight cases from 74 published case reports and 1 unpublished case were identified. Synchronous distant metastases were present in 37%. Analysis of case series (6192 patients) considered to carry a moderate risk of bias suggests an incidence of seeding after PEG insertion of 0.32%. Studies carrying a lower risk of bias indicate a risk of seeding closer to 1 in 2000. Conclusion The true risk of seeding after PEG insertion is probably less than 1 in 1000.

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“…However, cases of metastasis in patients in which a PEG was placed without instrument passage through the oral cavity or pharynx suggest alternate methods of tumor implantation . In fact, open gastrostomy and laparoscopic‐assisted gastrostomy tube insertion which both use entirely distinct surgical instruments to avoid tumor cross‐contamination, and result in greater expense, morbidity and recovery times, still have reported PEG site metastases, suggesting other mechanisms of seeding …”

Section: Discussionmentioning

confidence: 99%

Head and neck cancer PEG site metastases: Association with PEG placement method

Nye

Porter

et al. 2019

Head & Neck

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Background Many patients with head and neck cancer (HNC) will require feeding tube placement for nutritional support using percutaneous endoscopic gastrostomy (PEG) tube. Rarely, HNC metastases have been reported at the PEG site, a morbidity associated with a poor outcome. Methods Along with a case report, an evaluation of PEG placement methods with metastases from the literature was completed along with a statistical analysis of the literature to determine PEG site metastases and method of placement correlations. Results The incidence of PEG metastases in patients with HNC with the “pull” method is statistically identical to that of patients receiving any other method for PEG placement. Conclusions When considering options for the placement of PEG tubes in patients with HNC, the “pull” method should not be considered as a technique which will put patients at risk for PEG site metastases more than any other method of placement.

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Incidence of abdominal wall metastases following percutaneous endoscopic gastrostomy placement in patients with head and neck cancer

Abstract: Abdominal wall metastases following PEG placement are a rare but serious complication in patients with head and neck malignancy.

Cited by 30 publications

References 12 publications

Pain and Swelling after Percutaneous Endoscopic Gastrostomy Removal: An Unexpected Evolution

Pain and Swelling after Percutaneous Endoscopic Gastrostomy Removal: An Unexpected Evolution

Tumor implantation following percutaneous endoscopic gastrostomy insertion for head and neck and oesophageal cancer: Review of the literature

Head and neck cancer PEG site metastases: Association with PEG placement method

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