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Poonia DR, Rajappa SK, Dewan AK, Sehrawat A, Agrawal C, Venkata Pradeep Babu K. Exploring an Unfathomed Entiry: A Pooled Analysis of Solitory Skeletal Muscle Metastasis from Head and Neck Squamous Cell Carcinoma. J Maxillofac Oral Surg 2022; 21:176-183. [PMID: 35400920 PMCID: PMC8934890 DOI: 10.1007/s12663-020-01353-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 03/18/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Skeletal muscle is relatively uncommon site for metastasis in head and neck primary. This study was conducted to report our experience of three such cases and analyze the previously reported cases to assess the overall outcomes and formulate a treatment plan for these patients. METHODS We pooled the data extracted on extensive literature review and analyzed. RESULTS A total of 17 patients were analyzed for this study. All the patients had locally advanced primary and 14/17 developed metachronous metastasis. Median duration to development of metastasis was 8.5 months, and 13/17 patients had skeletal muscle as the only site of metastasis. Only 6/13 were treated with aggressive intent, 4 of which who underwent surgical resection had the best survival outcomes. CONCLUSIONS Isolated skeletal muscle metastasis in a head and neck primary is relatively rare, and in future, the research work needs to be taken up afresh, on prospective model, with adequate patient sample, to draw a scientifically valid conclusion.
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Affiliation(s)
- Dharma Ram Poonia
- grid.413618.90000 0004 1767 6103Department of Surgical Oncology, All India Institute of Medical Sciences, Rishikesh, India
- grid.418913.60000 0004 1767 8280Department of Surgical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Suhas Kodasoge Rajappa
- grid.418913.60000 0004 1767 8280Department of Surgical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Ajay K. Dewan
- grid.418913.60000 0004 1767 8280Department of Surgical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Amit Sehrawat
- grid.413618.90000 0004 1767 6103Department of Medical Oncology, All India Institute of Medical Sciences, Rishikesh, India
| | - Chaturbhuj Agrawal
- grid.418913.60000 0004 1767 8280Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Koyyala Venkata Pradeep Babu
- grid.418913.60000 0004 1767 8280Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
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2
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Poonia DR, Rajappa SK, Dewan AK, Sehrawat A, Agrawal C, Venkata Pradeep Babu K. Exploring an Unfathomed Entiry: A Pooled Analysis of Solitory Skeletal Muscle Metastasis from Head and Neck Squamous Cell Carcinoma. J Maxillofac Oral Surg 2020. [DOI: https://doi.org/10.1007/s12663-020-01353-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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3
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Montes de Oca MK, Nye A, Porter C, Collins J, Satterfield C, Schammel CMG, Trocha SD. Head and neck cancer PEG site metastases: Association with PEG placement method. Head Neck 2019; 41:1508-1516. [DOI: 10.1002/hed.25564] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 08/16/2018] [Accepted: 11/21/2018] [Indexed: 02/01/2023] Open
Affiliation(s)
- Mary K. Montes de Oca
- University of South Carolina School of Medicine Greenville Greenville South Carolina
| | - Anthony Nye
- University of South Carolina School of Medicine Greenville Greenville South Carolina
| | - Caroline Porter
- University of South Carolina School of Medicine Greenville Greenville South Carolina
| | - Justin Collins
- Institute for Translational Oncologic ResearchGreenville Health System Greenville South Carolina
| | | | | | - Steven D. Trocha
- Department of SurgeryGreenville Health System Greenville South Carolina
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4
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Shaw SM, Flowers H, O'Sullivan B, Hope A, Liu LWC, Martino R. The effect of prophylactic percutaneous endoscopic gastrostomy (PEG) tube placement on swallowing and swallow-related outcomes in patients undergoing radiotherapy for head and neck cancer: a systematic review. Dysphagia 2015; 30:152-75. [PMID: 25737196 DOI: 10.1007/s00455-014-9592-z] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 08/11/2014] [Indexed: 11/29/2022]
Abstract
Patients undergoing radiotherapy for head and neck cancer (HNC) often experience malnutrition and dehydration during treatment. As a result, some centres place PEG tubes prophylactically (pPEG) to prevent these negative consequences. However, recent research has suggested that pPEG use may negatively affect swallowing physiology, function and/or quality of life, especially in the long term. The purpose of this study was to systematically review the literature on pPEG use in HNC patients undergoing radiotherapy and to determine its impact on swallowing-related outcomes. The following electronic databases were searched for all relevant primary research published through February 24, 2014: AMED, CINAHL, the Cochrane Library, Embase, Healthstar, Medline, and PsycINFO. Main search terms included HNC, radiotherapy, deglutition disorders, feeding tube(s), and prophylactic or elective. References for all accepted papers were hand searched to identify additional relevant research. Methodological quality was assessed using Cochrane's Risk of Bias. At all levels, two blinded raters provided judgments. Discrepancies were resolved by consensus. The search retrieved 181 unique citations. Twenty studies met our inclusion criteria. Quality assessment revealed that all studies were at risk for bias due to non-randomized sampling and unreported or inadequate blinding. Ten studies demonstrated selection bias with significant baseline differences between pPEG patients and controls. Results regarding the frequency and severity of dysphagia and swallowing-related outcomes were varied and inconclusive. The impact of pPEG use on swallowing and swallowing-related outcomes remains unclear. Well-controlled, randomized trials are needed to determine if pPEG places patients at greater risk for developing long-term dysphagia.
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Affiliation(s)
- Stephanie M Shaw
- Department of Speech-Language Pathology, Faculty of Medicine, University of Toronto, 160-500 University Ave., Toronto, ON, M5G 1V7, Canada,
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Mohan AM, Balaguhan B, Krishna V, Nagarjuna M. Squamous Cell Carcinoma of the Pectoralis Major Myocutaneous Flap Donor Site. J Oral Maxillofac Surg 2014; 72:1425-31. [DOI: 10.1016/j.joms.2013.12.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 12/14/2013] [Accepted: 12/19/2013] [Indexed: 10/25/2022]
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6
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Percutaneous endoscopic gastrostomy site metastasis from head and neck squamous cell carcinoma: case series and literature review. J Otolaryngol Head Neck Surg 2013; 42:20. [PMID: 23672761 PMCID: PMC3651229 DOI: 10.1186/1916-0216-42-20] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Accepted: 01/06/2013] [Indexed: 02/01/2023] Open
Abstract
Objectives To present our experience with head and neck squamous cell carcinoma (HNSCC) seeding of percutaneous endoscopic gastrostomy (PEG) sites and to review all reported cases to identify risk factors and develop strategies for complication avoidance. Materials and methods The records of 4 patients with PEG site metastasis from HNSCC were identified from the authors’ institution. Thirty-eight further cases were reviewed following a PubMed search and evaluation of references in pertinent articles. Results Review of 42 cases revealed the average time from PEG to diagnosis of metastatic disease to be 8 months. Average time to death from detection of PEG disease was 5.9 months. One-year survival following PEG metastasis was 35.5% with an overall mortality of 87.1%. Conclusion PEG site metastatic disease portends a poor prognosis. Early detection and aggressive therapy may provide a chance of cure. Changes in PEG technique or in timing of adjunctive therapies are possible avenues in further research to prevent this complication.
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7
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Sheykholeslami K, Thomas J, Chhabra N, Trang T, Rezaee R. Metastasis of untreated head and neck cancer to percutaneous gastrostomy tube exit sites. Am J Otolaryngol 2012; 33:774-8. [PMID: 22917953 DOI: 10.1016/j.amjoto.2012.07.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Accepted: 07/16/2012] [Indexed: 02/01/2023]
Abstract
BACKGROUND Percutaneous endoscopic gastrostomy (PEG) has become a mainstay in providing enteral access for patients with obstructive head and neck tumors. PEG tube placement is considered safe and complications are infrequent. METHODS A comprehensive review of the literature in MEDLINE (1962-2011) was performed. We report herein 3 new cases. RESULTS The literature search revealed 43 previous cases. The interval between PEG placement and diagnosis of metastasis ranged from 1 to 24 months. CONCLUSIONS Metastatic cancer should be considered in patients with head and neck cancer that have persistent, unexplained skin changes at PEG site, anemia, or guaiac positive stools without a clear etiology. The direct implantation of tumor cells through instrumentation is the most likely explanation, although hematogenous and/or lymphatic seeding is also a possibility. Our review of the literature and clinical experience indicate that the "pull" technique of PEG placement may directly implant tumor cells at the gastrostomy site.
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Palwe V, Talpatra K, Mahantshetty U, Viswanathan S. Metastatic Implantation of Head and Neck Squamous Cell Cancer at PEG Tube Site Exit— An Unusual Relapse Site: A Case Report and Review of Literature. ACTA ACUST UNITED AC 2011. [DOI: 10.5005/jp-journals-10001-1048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
ABSTRACT
Background
The placement of percutaneous endoscopic gastrostomy (PEG) tubes is a common procedure in patients with head and neck cancer who require adequate nutrition because of the inability to swallow before or after surgery and adjuvant therapies. A potential complication of percutaneous endoscopic gastrostomy tubes is the metastatic spread from the original head and neck tumor to the gastrostomy site.
Methods
This is a case of a 55-year-old male with a (cT4N3M0) stage IV squamous cell carcinoma of the oropharynx who underwent percutaneous endoscopic gastrostomy tube placement prior to commencement of definitive chemoradiation therapy and 7 months thereafter developed metastatic spread to the gastrostomy site. Tumor was treated with radiation therapy. A review of the published literature regarding the subject is done. The pull-through method of gastrostomy tube placement had been used in our patient as well as in the majority of the other cases reviewed in the literature.
Conclusions
There is a small but definite risk for tumor implantation in the gastrostomy site when using the pull technique in patients with active head and neck cancer. The direct implantation of tumor through instrumentation is the most likely explanation for metastasis; however, hematogenous seeding is also a possibility. Careful assessment of the oropharynx and hypopharynx before PEG tube placement and the use of alternative techniques for enteral access in patients with untreated or residual malignancy are recommended to minimize this risk.
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9
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Barber AJ, Lowe D, Lal S, Rogers SN. Survey of gastrostomy insertion technique used in oncology patients in UK Oral and Maxillofacial units. J Craniomaxillofac Surg 2010; 38:60-3. [DOI: 10.1016/j.jcms.2009.09.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2009] [Revised: 07/28/2009] [Accepted: 09/11/2009] [Indexed: 12/27/2022] Open
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Seeding of the Percutaneous Endoscopic Gastrostomy Tract from Esophageal Squamous Cell Cancer Presenting as an Acutely Bleeding Malignant Gastric Ulcer: A Novel Clinicoendoscopic Presentation. South Med J 2008; 101:35-9. [PMID: 18176289 DOI: 10.1097/smj.0b013e31815d28d2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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11
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Tsai JK, Schattner M. Percutaneous endoscopic gastrostomy site metastasis. Gastrointest Endosc Clin N Am 2007; 17:777-86. [PMID: 17967381 DOI: 10.1016/j.giec.2007.07.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Metastases to gastrostomy sites are a rare but significant complication of percutaneous endoscopic gastrotomy (PEG) placement in cancer patients. Both direct seeding and hematogenous spread have been suggested as possible mechanisms. This article outlines the incidence, presentation, pathogenesis, and management of PEG-site metastases.
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Affiliation(s)
- John K Tsai
- Gastroenterology and Nutrition Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10021, USA
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12
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Cappell MS. Risk factors and risk reduction of malignant seeding of the percutaneous endoscopic gastrostomy track from pharyngoesophageal malignancy: a review of all 44 known reported cases. Am J Gastroenterol 2007; 102:1307-11. [PMID: 17488255 DOI: 10.1111/j.1572-0241.2007.01227.x] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
AIM To comprehensively review all known reported cases of stomal metastases after percutaneous endoscopic gastrostomy (PEG) to systematically identify risk factors for this complication and to develop strategies for reducing this risk. METHODS Reported cases were identified by computerized literature searches. Criteria for risk factors for stomal metastases included: a substantially higher relative rate of this factor in patients with stomal metastases than expected from pharyngoesophageal malignancy in general, and biologic plausibility of this phenomenon. LITERATURE REVIEW Review of all 44 known stomal metastases revealed the following. The mean patient age was 59.0+/-10.0 (SD) yr, and 79% of patients were male. Pathologically proven stomal metastases were located in the abdominal wall (PEG exit site) in 63%, in the gastric wall (PEG entrance site) in 7%, and in both walls in 30%. Mean survival after diagnosis was only 4.3+/-3.8 months. Pathologic risk factors for stomal metastases included: (a) pharyngoesophageal location of primary cancer (in 100% of cases, 0% other locations); (b) squamous cell histology (in 98%, adenocarcinoma in 2%); (c) poorly or moderately differentiated histology (in 92%, well differentiated in 8%); (d) advanced pathologic stage (in 97%, early stage in 3%); and (e) large primary cancer size at diagnosis (mean diameter 4.2+/-2.3 cm). These risk factors appeared to be quantitatively large (e.g., 98% of cases had squamous histology vs 50% expected rate, odds ratio 40.1, OR CI 6.31-246.4, P<0.0001). Therapeutic risk factors for stomal metastases included: (a) endoscopic PEG placement (in 98%, surgical gastrostomy in 2%); (b) pull-string PEG technique (in 98%, push-guidewire in 2%, direct-introducer in 0%); (c) primary cancer untreated or known local recurrence after treatment before PEG (in 87%); and (d) time>or=3 months after PEG insertion (in 100%, <3 months in 0%; mean interval 7.8+/-5.2 months after PEG). Four of the currently reported risk factors are novel (pathologic factors d,e; therapeutic factors a,d). CONCLUSIONS Strong risk factors for stomal metastases include: pharyngoesophageal primary cancer, squamous cell histology, less well-differentiated cancer, large size, and advanced cancer stage. The risk may be reduced in patients with risk factors by radiotherapy, chemotherapy, or cancer surgery before PEG; by substituting the push-guidewire for the pull-string technique for PEG; and possibly by use of a sheath with the pull-string technique.
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Affiliation(s)
- Mitchell S Cappell
- Division of Gastroenterology, Department of Medicine, William Beaumont Hospital, Royal Oak, Michigan 48073, USA
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13
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Foster JM, Filocamo P, Nava H, Schiff M, Hicks W, Rigual N, Smith J, Loree T, Gibbs JF. The introducer technique is the optimal method for placing percutaneous endoscopic gastrostomy tubes in head and neck cancer patients. Surg Endosc 2006; 21:897-901. [PMID: 17180272 DOI: 10.1007/s00464-006-9068-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2006] [Revised: 06/21/2006] [Accepted: 07/31/2006] [Indexed: 01/25/2023]
Abstract
BACKGROUND Percutaneous endoscopic gastrostomy (PEG) tubes are often placed in head and neck cancer patients to provide nutritional support, but studies have found the complication rates to be higher than other subsets of patients who undergo PEG placement. Complication rates as high as 50% have been reported, with the bulk of these complications being PEG site issues (i.e., cellulitis, abscess, fascitis, and tumor implantation). Because the pull technique has been the primary technique used, the theory is that the transoral tube passage is the source of the complications in these patients. Alternatively, the introducer technique uses a transabdominal approach to place the device, avoiding any tube contamination by upper aerodigestive organisms or tumor cells. At our institution, this technique has been used exclusively for head and neck cancer patients and this article reports our experience. METHODS One hundred forty-nine head and neck cancer patients who had a prophylactic PEG tube placed were reviewed from January 1, 1999 to December 31, 2003. The rates of placement success, morbidity, and complications were determined. RESULTS Successful placement was achieved in 148 (99%) patients without any PEG-related deaths. Overall, 17 complications (11%) occurred, with only one major complication (0.7%) identified. PEG site infections were uncommon with only five cases (3.4%) and all were mild cellulitis. CONCLUSIONS The introducer technique is the safest method for PEG tube placement in head and neck cancer patients. The overall rate of complications is low and PEG site infectious complications are rare. The introducer technique should be the method of choice for PEG tubes in head and neck cancer patients.
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Affiliation(s)
- Jason M Foster
- Department of Surgery, Roswell Park Cancer Institute, State University of New York at Buffalo, Buffalo, NY, USA
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14
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Coletti D, Genuit T, Ord R, Engroff S. Metastasis to the percutaneous endoscopic gastrostomy site in the patient with head and neck cancer: a case report and review of the literature. J Oral Maxillofac Surg 2006; 64:1149-57. [PMID: 16781352 DOI: 10.1016/j.joms.2006.03.018] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Domenick Coletti
- Department of Oral and Maxillofacial Surgery, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
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15
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Maetani I, Sakai Y. REDUCING THE RISK OF PERISTOMAL INFECTION AFTER PEG PLACEMENT. Dig Endosc 2005. [DOI: 10.1111/j.1443-1661.2005.00546.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
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16
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Hawken RMA, Williams RW, Bridger MWM, Lyons CBA, Jackson SA. Puncture-site metastasis in a radiologically inserted gastrostomy tube: case report and literature review. Cardiovasc Intervent Radiol 2005; 28:377-80. [PMID: 15886946 DOI: 10.1007/s00270-004-0106-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Gastrostomy-site metastases from head and neck cancer have been reported numerous times following endoscopic insertion, with direct implantation being implicated. We present the first reported case of gastrostomy-site metastasis following radiological insertion, and discuss the mechanisms by which this may have occurred. These include: direct implantation, hematogenous dissemination, or the natural shedding of tumor cells into the gastrointestinal tract.
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Affiliation(s)
- R M A Hawken
- Department of ENT Surgery, Derriford Hospital, Plymouth, Devon, UK
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17
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Adelson RT, Ducic Y. Metastatic head and neck carcinoma to a percutaneous endoscopic gastrostomy site. Head Neck 2005; 27:339-43. [PMID: 15712297 DOI: 10.1002/hed.20159] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Percutaneous endoscopic gastrostomy (PEG) tube placement is a safe and widely accepted alternate route for enteral alimentation in the head and neck cancer patient population. Cancer metastatic to a PEG tube exit site is a rare but serious complication of this procedure. We sought to determine the route of spread responsible for PEG site metastases such that we may prevent further occurrences of this highly morbid condition. We also report a case of PEG site metastasis at our institution. METHODS We performed a MEDLINE search for the years 1962 to 2002 and conducted a review of the literature. In the case at our institution, a 63-year-old man was referred to our institution with recurrent squamous cell carcinoma of the right base of tongue; he also had a 1.5-cm left apical lung nodule. He underwent PEG tube placement at the time of staging panendoscopy. Six months after the original tube placement, he had an ulcerated mass develop at the PEG site; biopsy of the mass revealed squamous cell carcinoma histologically identical to the base of tongue tumor. He also had recurrent lung cancer and four hepatic lesions develop. RESULTS In our MEDLINE search, of the five patients diagnosed with PEG site disease >10 months after PEG placement, all five (100%) had synchronous distant metastatic disease. In the group of patients diagnosed with PEG site metastases < or =10 months after PEG placement, only four (24%) of 17 had synchronous distant metastatic disease. All patients underwent PEG placement by means of the "pull" technique. Direct implantation with a variable-sized initial tumor burden can explain all cases of PEG site metastasis. The presence of distant metastases is representative of the natural history of advanced head and neck malignancies. Smaller initial tumor implants present later than would larger initial tumor burdens, when the patient is more likely to have distant metastatic disease. In the case at our institution, the patient did not respond to treatment for his hepatic and PEG site metastases and his lung cancer, and he died 4 months after detection of the PEG site metastasis. CONCLUSIONS PEG site metastases are iatrogenic complications of PEG tube placement in patients with squamous cell carcinoma of the upper aerodigestive tract. The use of laparoscopic, open, or the "push" technique of PEG tube placement in patients with head and neck cancer may prevent direct implantation of malignant cells into an enteral access site.
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Affiliation(s)
- Robert Todd Adelson
- Department of Otolaryngology-Head and Neck Surgery at the University of Texas Southwestern Medical Center in Dallas, Texas, USA
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18
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Raman S, Siddiq TO, Joseph A, Jones AH, Haray PN, Masoud AG. Vaccination metastasis following percutaneous endoscopic gastrostomy. ACTA ACUST UNITED AC 2004; 65:246-7. [PMID: 15127685 DOI: 10.12968/hosp.2004.65.4.12743] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- S Raman
- Prince Charles Hospital, Merthyr Tydfil, Mid Glamorgan CF47 9DT
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Thakore JN, Mustafa M, Suryaprasad S, Agrawal S. Percutaneous endoscopic gastrostomy associated gastric metastasis. J Clin Gastroenterol 2003; 37:307-11. [PMID: 14506388 DOI: 10.1097/00004836-200310000-00009] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
An interesting case of gastric metastasis of head and neck cancer after percutaneous endoscopic gastrostomy (PEG) placement is presented. Gastric metastases may appear in 3 morphologic varieties endoscopically. They may be multiple nodules of varying size, submucosal tumor masses with tip ulceration, or nonulcerated masses. Histologically, they may be seen as microscopic infiltration, a gross nodule, gross ulceration, or a gross hypertrophied wall. A case of PEG associated gastric metastasis has been reported almost every year since 1989. Even then, PEG placement by pull method continues to be a common procedure for patients diagnosed with head and neck cancer. The mechanism of gastric metastasis in patients with PEG is unclear. Seeding as well as hematogenous and lymphatic spread to traumatized tissue may be the cause.
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20
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Ananth S, Amin M. Implantation of oral squamous cell carcinoma at the site of a percutaneous endoscopic gastrostomy: a case report. Br J Oral Maxillofac Surg 2002; 40:125-30. [PMID: 12180203 DOI: 10.1054/bjom.2001.0740] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
A 55-year-old man had an operation and radiotherapy for a squamous cell carcinoma of the oral cavity and developed a metastatic deposit at the site of a percutaneous endoscopic gastrostomy, with no other evidence of systemic spread. Treatment of the metastasis was by neo-adjuvant chemotherapy with cisplatin and 5-fluorouracil (5-FU) followed by en bloc resection of the stomal recurrence on the anterior abdominal wall. There has been no evidence of recurrence to date. Only 17 other cases of metastasis to this site from a primary tumour in the upper aerodigestive tract have been reported. We review the relevant publications and discuss the techniques, complications and possible mechanisms of spread and their implications for the use of percutaneous endoscopic gastrostomy in head and neck cancer surgery.
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Affiliation(s)
- S Ananth
- Department of Oral and Maxillofacial Surgery, Royal Berkshire Hospital, Reading, UK.
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21
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Bhama JK, Haas MK, Fisher WE. Spread of a pharyngeal cancer to the abdominal wall after percutaneous endoscopic gastrostomy. Surg Laparosc Endosc Percutan Tech 2001; 11:375-8. [PMID: 11822863 DOI: 10.1097/00129689-200112000-00008] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Percutaneous endoscopic gastrostomy is frequently used in patients with head and neck cancer to establish enteral access for feeding. Spread of head and neck cancer to the gastrostomy site is a rare but increasingly reported complication after percutaneous endoscopic placement. We report the 13th such case in the literature, occurring in a 51-year-old black man with squamous cell carcinoma of the hypopharynx. The mode of tumor spread to the gastrostomy site remains debatable. Evidence exists for hematogenous dissemination and direct implantation. We think percutaneous endoscopic techniques for enteral access in this patient population are contraindicated, and we advocate a laparoscopic approach for gastrostomy placement.
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Affiliation(s)
- J K Bhama
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, The Veteran Affairs Medical Center, Houston, Texas 77030, USA
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22
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Bhama J, Haas M, Fisher W. Surg Laparosc Endosc Percutan Tech 2001; 11:375-378. [DOI: 10.1097/00019509-200112000-00008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Sinclair JJ, Scolapio JS, Stark ME, Hinder RA. Metastasis of head and neck carcinoma to the site of percutaneous endoscopic gastrostomy: case report and literature review. JPEN J Parenter Enteral Nutr 2001; 25:282-5. [PMID: 11531220 DOI: 10.1177/0148607101025005282] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Patients with head and neck cancer often need a percutaneous endoscopic gastrostomy to provide adequate nutrition because of inability to swallow after tumor radiation therapy. However, metastasis of the original tumor to the gastrostomy exit site may occur. METHODS We describe the case of a 61-year-old man with stage III (T2 N1) squamous cell carcinoma of the tongue in whom a PEG tube was placed to circumvent anticipated difficulties in swallowing after radiation therapy. We also compare this case with similar cases in the literature. RESULTS Soreness and erythema near the gastrostomy site reported by the patient were diagnosed as cellulitis, and two courses of antibiotic treatment were prescribed. However, a biopsy showed that the original squamous cell carcinoma had metastasized to the gastrostomy exit site. The "pull" method of tube placement had been used in this patient and in all 19 cases of metastasis reported in the literature. CONCLUSIONS Metastatic cancer should be considered in patients with head and neck cancer who have unexplained skin changes at the gastrostomy site. Our experience with this case and review of the literature indicate that, in patients with head and neck cancer, "pull" procedures for placement of gastrostomy tubes may induce metastasis by direct implantation of tumor cells because of contact between the gastrostomy tube and tumor cells. Methods of tube insertion that avoid such contact are preferred.
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Affiliation(s)
- J J Sinclair
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida 32224, USA
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Scolapio JS, Spangler PR, Romano MM, McLaughlin MP, Salassa JR. Prophylactic placement of gastrostomy feeding tubes before radiotherapy in patients with head and neck cancer: is it worthwhile? J Clin Gastroenterol 2001; 33:215-7. [PMID: 11500610 DOI: 10.1097/00004836-200109000-00009] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
BACKGROUND After radiation treatment of head and neck cancer, placement of gastrostomy feeding tubes can be technically difficult. The practice of placing tubes before treatment is probably justified if the tube is used for more than 4 weeks and if complications are infrequent. The aim of this study was to determine the outcome of prophylactically placed gastrostomy tubes in patients with head and neck cancer at our institution from 1995 to 1999. STUDY Data collected retrospectively from the patients' medical records included demographics, duration of tube use, and complications associated with placement. RESULTS A total of 54 patients (40 men, 14 women) with a mean age of 68.5 years (range, 49-88 years) were studied. Thirty-one patients were treated with both surgery and radiotherapy; 17, with only radiotherapy; and 6, with chemotherapy, radiation, and surgery. The gastrostomy tube was placed before initiation of radiation treatment in 41 patients and after treatment in 13. The method of placement included pull technique (n = 41), introducer technique (n = 10), and surgical (n = 3). Four patients who had a tube placed after treatment required hospitalization for dehydration, whereas no hospitalizations were needed in the prophylactic group. The median duration of tube use was 165 days (range, 0-1,105 days). Only three patients had a complication directly related to placement. CONCLUSION Gastrostomy tube placement before treatment is appropriate, given the median number of days required for use and limited complications associated with placement.
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Affiliation(s)
- J S Scolapio
- Division of Gastroenterology, Department of Radiation Oncology, Mayo Clinic, Jacksonville, Florida 32224, USA.
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Schneider C, Jung A, Reymond MA, Tannapfel A, Balli J, Franklin ME, Hohenberger W, Köckerling F. Efficacy of surgical measures in preventing port-site recurrences in a porcine model. Surg Endosc 2001; 15:121-5. [PMID: 11285951 DOI: 10.1007/s004640010069] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Port-site recurrences are serious complications of laparoscopy performed for cancer. Incidences reported in the literature vary between 0% and 21%, suggesting an influence of the surgeon. METHODS The aim of this experimental, prospective, randomized, single-blind study was to investigate the influence that the quality surgery has on the incidence of port-site recurrences. After a 12-mmHg carbon dioxide (CO2) pneumoperitoneum was created, 10(7) human HeLa cell were injected into the peritoneal cavity of 18 pigs, creating a xenogeneic tumor. Laparoscopic sigmoid resections then were performed using four trocars and a transanal double-stapling technique. The following protective measures were applied in nine animals: trocar fixation, prevention of gas leaks, rinsing of instruments with povidone-iodine, minilaparotomy protection, rinsing of trocars before removal, peritoneal closure, and rinsing of all wounds with povidoneiodine. Surgeons and type of procedures were randomized. After 4 weeks, the animals were killed and all portsites excised. Blinded immunohistologic analysis with antihuman pancytokeratin antibody was performed. RESULTS Tumor recurrence was present in 23 of 36 port sites (63.8%) in the control group, but only in 5 of 36 port sites (13.8%) in the group that received protective measures (p = 0.002; Fisher's exact test). No peritoneal carcinosis nor anastomotic recurrences were observed. CONCLUSION These results strongly suggest that the quality of surgical technique has an influence on the incidence of port-site recurrences. From now on, we propose to use these protective measures routinely in cancer laparoscopy.
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Affiliation(s)
- C Schneider
- Department of Surgery and Pathology, University of Erlangen, Germany
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Brown MC. Cancer metastasis at percutaneous endoscopic gastrostomy stomata is related to the hematogenous or lymphatic spread of circulating tumor cells. Am J Gastroenterol 2000; 95:3288-91. [PMID: 11095357 DOI: 10.1111/j.1572-0241.2000.03339.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Percutaneous endoscopic gastrostomy (PEG) has become a mainstay in providing enteral access for patients with obstructive oropharyngeal and esophageal tumors. PEG tube placement is considered safe, and complications are infrequent. One complication, although rare, that is being increasingly reported is the metastasis of cancer at PEG stomata. Herein, a case of metastasis of an esophageal cancer at a PEG stoma is described. Although it has been previously suggested that cancer metastasis is due to direct seeding of the stoma, an analysis of the literature suggests that this phenomenon is related to the hematogenous or lymphatic spread of cancer cells to a susceptible site.
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Affiliation(s)
- M C Brown
- Department of Medicine, University of Washington Medical Center, Seattle, USA
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Peghini PL, Guaouguaou N, Salcedo JA, Al-Kawas FH. Implantation metastasis after PEG: case report and review. Gastrointest Endosc 2000; 51:480-2. [PMID: 10744826 DOI: 10.1016/s0016-5107(00)70451-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- P L Peghini
- Georgetown University Medical Center, Washington, DC 20007-2197, USA
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Raynor EM, Williams MF, Martindale RG, Porubsky ES. Timing of percutaneous endoscopic gastrostomy tube placement in head and neck cancer patients. Otolaryngol Head Neck Surg 1999; 120:479-82. [PMID: 10187937 DOI: 10.1053/hn.1999.v120.a91408] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Percutaneous endoscopic gastrostomy (PEG) is an effective method for providing alimentation in patients with upper aerodigestive tract carcinoma. Multiple complications of this procedure have been reported, ranging from leakage around the tube to tumor seeding of the abdominal cavity. This study was undertaken to determine whether the timing of PEG tube placement with respect to primary tumor extirpation led to a difference in the number and severity of observed complications. The medical records of 43 patients with head and neck carcinoma who had PEG tubes placed from 1995 to 1996 were retrospectively reviewed. Comparisons of timing of PEG tube placement, complication, location, and stage of the primary tumor were performed. In addition, the use of adjuvant therapy with respect to the time of PEG tube placement and complications was evaluated. Of these, 23% were done before and 30% during surgery at the time of primary tumor resection (9 of 13 were after primary removal). One patient had an intraabdominal abscess. Minor complications occurred in 15 of 43 patients (35%) and included granulation tissue at the PEG site, leakage, and tube displacement. Eight of the 9 patients who underwent intraoperative PEG after tumor resection had no complications. Patients who underwent PEG during or after surgery had significantly fewer complications than those who underwent preoperative PEG or had unresectable tumors (P = 0.038). The largest number of complications occurred in patients who underwent preoperative PEG (57%) followed by patients whose tumors were unresectable (31%). There was no statistical difference with regard to tumor location or postoperative x-ray therapy in PEG complications. This study demonstrates that PEG tube placement after tumor resection has the lowest incidence of postoperative complications. Performing PEGs intraoperatively after tumor resection can prevent the need for additional anesthesia to provide alimentation in patients with upper aerodigestive tract carcinoma.
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Affiliation(s)
- E M Raynor
- Department of Surgery, Medical College of Georgia, Augusta 30912, USA
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Abstract
This study evaluates our complications arising directly or indirectly from placement or management of percutaneous endoscopic gastrostomy (PEG) tubes and provides recommendations for avoidance of complications. Seventy-one patients received PEG tube placement by otolaryngologists between January 1991 and May 1997. Records were reviewed for diagnoses, combined procedures, and complications. Addressing potential causes of complications prompted modification of our technique of PEG tube placement and management. Twenty-three patients received PEG for dysphagia/aspiration unrelated to neoplasia, 11 received PEG with staging endoscopy, 11 received PEG after treatment for head and neck neoplasm, and 26 received PEG at the time of primary resection. Major complications included retained PEG hub and delayed colon abscess ultimately resulting in death. Minor complications included skin abscesses, cellulitis, and early and late vasovagal response with PEG tube removal. An airway emergency, on attempted oral airway intubation, resulted in an aborted PEG attempt and constituted another complication outside the 4 groups stated above. The major complication was not found within a literature review. We have modified our management for avoidance of this complication. We believe the causes of the minor complications have been identified, and with additional modifications in our technique, we have not had any similar complications recently. The recommended techniques are discussed in detail.
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Affiliation(s)
- P M Santos
- Division of Otolaryngology, Southern Illinois University School of Medicine, USA
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Luck A, Hewett P. Laparoscopic gastrostomy: towards the ideal technique. THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY 1998; 68:281-3. [PMID: 9572339 DOI: 10.1111/j.1445-2197.1998.tb02083.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Laparoscopic gastrostomy is the best option for long-term gastric intubation when percutaneous endoscopic gastrostomy is not possible. The ideal technique is yet to be defined. METHODS A technique of suturing the gastric wall to the posterior rectus sheath under direct vision has been developed. The method is simple and avoids the difficulties and potential complications described with other techniques. RESULTS The technique has been used in three cases with excellent results and no complications. CONCLUSION The described technique is a further advance in defining the 'ideal' technique of laparoscopic gastrostomy.
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Affiliation(s)
- A Luck
- Department of Surgery, Queen Elizabeth Hospital, Woodville South, South Australia, Australia
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Madan AK, Batra AK. Percutaneous endoscopic gastrostomy in the elderly: complications (review). JOURNAL OF NUTRITION FOR THE ELDERLY 1996; 15:39-49. [PMID: 8949018 DOI: 10.1300/j052v15n04_04] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Due to varying disease processes, the elderly may have limited oral access to their otherwise intact gastrointestinal tract. In such individuals, the intact gastrointestinal tract must be accessed in other ways. Until the early 1980s, choices were limited to temporary solutions such as the nasogastric tube or to long operative procedures such as the operative gastrostomy tube. The introduction of percutaneous endoscopic gastrostomy (PEG) allowed a quick, safe, and cheap procedure as an option. While PEG tubes have been used to help many of the elderly with their nutritional needs, they are not without risks. Below is a review of the literature concerning PEG complications in the elderly.
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Strodel WE, Kenady DE. Stomal seeding of head and neck cancer by percutaneous endoscopic gastrostomy (PEG) tube. Ann Surg Oncol 1995; 2:462-3. [PMID: 7496844 DOI: 10.1007/bf02306382] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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