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Uloza V, Kuzminienė A, Palubinskienė J, Balnytė I, Ulozienė I, Valančiūtė A. Laryngeal carcinoma experimental model suggests the possibility of tumor seeding to gastrostomy site. Med Hypotheses 2021; 150:110573. [PMID: 33799159 DOI: 10.1016/j.mehy.2021.110573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/28/2021] [Accepted: 03/13/2021] [Indexed: 11/15/2022]
Abstract
Some studies state that laryngeal squamous cell carcinoma (LSCC) is associated with possible direct tumor cell seeding to percutaneous endoscopic gastrostomy (PEG) site. However, there is a lack of experimental proof that LSCC tumor tissue can adhere and grow in distant sites. Therefore, we aimed to investigate the growth pattern of LSCC implants on chicken embryo chorioallantoic membrane (CAM) and evaluate possible associations between clinical course of the disease and behavior of experimentally implanted LSCC tumors. Our results show that implanted LSCC tissue survives on CAMs in 95% of cases while retaining essential morphologic characteristics and proliferative capacity of the original tumor. We identified the increased CAM vascularization, an infiltrative growth pattern of the implant and formation of distant isolated metastatic nodes on the CAMs. LSCC tumors with worse differentiation degree (G2 or G3) adhered to the experimental CAMs significantly better than G1. These results facilitate the understanding of tumor biology and allow hypothetisezing that dissemination and direct implantation of LSCC cells into the stomal wall during the pull PEG procedure might be possible.
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Affiliation(s)
- Virgilijus Uloza
- Department of Otorhinolaryngology, Lithuanian University of Health Sciences, Eiveniu 2, Kaunas, LT 50009, Lithuania.
| | - Alina Kuzminienė
- Department of Otorhinolaryngology, Lithuanian University of Health Sciences, Eiveniu 2, Kaunas, LT 50009, Lithuania.
| | - Jolita Palubinskienė
- Department of Histology and Embryology, Lithuanian University of Health Sciences, A. Mickevičiaus g. 9, Kaunas, LT 44307, Lithuania.
| | - Ingrida Balnytė
- Department of Histology and Embryology, Lithuanian University of Health Sciences, A. Mickevičiaus g. 9, Kaunas, LT 44307, Lithuania.
| | - Ingrida Ulozienė
- Department of Otorhinolaryngology, Lithuanian University of Health Sciences, Eiveniu 2, Kaunas, LT 50009, Lithuania.
| | - Angelija Valančiūtė
- Department of Histology and Embryology, Lithuanian University of Health Sciences, A. Mickevičiaus g. 9, Kaunas, LT 44307, Lithuania.
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Siu J, Fuller K, Nadler A, Pugash R, Cohen L, Deutsch K, Enepekides D, Karam I, Husain Z, Chan K, Singh S, Poon I, Higgins K, Xu B, Eskander A. Metastasis to gastrostomy sites from upper aerodigestive tract malignancies: a systematic review and meta-analysis. Gastrointest Endosc 2020; 91:1005-1014.e17. [PMID: 31926149 DOI: 10.1016/j.gie.2019.12.045] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 12/26/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Metastasis to the gastrostomy site in patients with upper aerodigestive tract (UADT) malignancies is a rare but devastating adverse event that has been poorly described. Our aim was to determine the overall incidence and clinicopathologic characteristics observed with development of gastrostomy site metastasis in patients with UADT cancers. METHODS This was a systematic review and meta-analysis of 6138 studies retrieved from Medline, EMBASE, CINAHL, and the Cochrane Register after being queried for studies including gastrostomy site metastasis in patients with UADT malignancies. RESULTS The final analysis included 121 studies. Pooled analysis showed an overall event rate gastrostomy site metastasis of .5% (95% confidence interval [CI], .4%-.7%). Subgroup analysis showed an event rate of .56% (95% CI, .40%-.79%) with the pull technique and .29% (95% CI, .15%-.55%) with the push technique. Clinicopathologic characteristics observed with gastrostomy site metastasis were late-stage disease (T3/T4) (57.8%), positive lymph node status (51.2%), and no evidence of systemic disease (M0) (62.8%) at initial presentation. The average time from gastrostomy placement to diagnosis of metastasis was 7.78 ± 4.9 months, average tumor size on detection was 4.65 cm (standard deviation, 2.02), and average length of survival was 7.26 months (standard deviation, 6.23). CONCLUSIONS Gastrostomy site metastasis is a rare but serious adverse event that occurs at an overall rate of .5%, particularly in patients with advanced-stage disease, and is observed with a very poor prognosis. These findings emphasize a need for clinical practice guidelines to include a regular assessment of the PEG site and highlight the importance of detection and management of gastrostomy site metastasis by the multidisciplinary care oncology team.
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Affiliation(s)
- Jennifer Siu
- Department of Otolaryngology-Head and Neck Cancer Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Kaitlin Fuller
- Gerstein Science Information Centre, University of Toronto Libraries, Toronto, Ontario, Canada
| | - Ashlie Nadler
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Robyn Pugash
- Vascular/Interventional Radiology, Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Lawrence Cohen
- Division of Gastroenterology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Konrado Deutsch
- Department of Otolaryngology-Head and Neck Cancer Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Danny Enepekides
- Department of Otolaryngology-Head and Neck Cancer Surgery, University of Toronto, Toronto, Ontario, Canada; Head & Neck Surgical Oncology, University of Toronto, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Irene Karam
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Zain Husain
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Kelvin Chan
- Division of Medical Oncology, University of Toronto, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Canadian Centre for Applied Research in Cancer Control, Toronto, Canada
| | - Simron Singh
- Division of Medical Oncology, University of Toronto, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Ian Poon
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Kevin Higgins
- Department of Otolaryngology-Head and Neck Cancer Surgery, University of Toronto, Toronto, Ontario, Canada; Head & Neck Surgical Oncology, University of Toronto, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Bin Xu
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Antoine Eskander
- Department of Otolaryngology-Head and Neck Cancer Surgery, University of Toronto, Toronto, Ontario, Canada; Head & Neck Surgical Oncology, University of Toronto, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Otolaryngology-Head & Neck Surgery, Surgical Oncology, Michael Garron Hospital, Toronto, Ontario, Canada; Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Science, Toronto, Ontario, Canada
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A case of abdominal wall percutaneous endoscopic gastrostomy site metastatic disease from primary oropharyngeal squamous cell carcinoma. Eur J Nucl Med Mol Imaging 2020; 47:1011-1012. [PMID: 31989277 DOI: 10.1007/s00259-020-04700-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 01/14/2020] [Indexed: 10/25/2022]
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Strijbos D, Keszthelyi D, Gilissen LPL, Lacko M, Hoeijmakers JGJ, van der Leij C, de Ridder RJJ, de Haan MW, Masclee AAM. Percutaneous endoscopic versus radiologic gastrostomy for enteral feeding: a retrospective analysis on outcomes and complications. Endosc Int Open 2019; 7:E1487-E1495. [PMID: 31673622 PMCID: PMC6811353 DOI: 10.1055/a-0953-1524] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 02/07/2018] [Indexed: 12/12/2022] Open
Abstract
Background and study aims Percutaneous endoscopic gastrostomy (PEG) and percutaneous radiologic gastrostomy (PRG) are techniques used for long-term enteral feeding. Our primary aim was to analyze procedure-related and 30-day mortality and complications between PEG and PRG in relation to indications. Patients and methods A single-center retrospective analysis was performed thath included all adult patients receiving initial PEG (January 2008 until April 2016) and PRG (January 2010 until April 2016). Outcomes were mortality (procedure-related, 30-day), complications (early (≤ 30 days) and late) and success rates. Results A total of 760 procedures (469 PRG and 291 PEG) were analyzed. Most common indications were head and neck cancer (HNC), cerebrovascular accident (CVA) and amyotrophic lateral sclerosis (ALS). Success rates for placement were 91.2 % for PEG and 97.1 % for PRG ( P = 0.001). Procedure-related mortality was 1.7 % in PEG and 0.4 % in PRG ( P = 0.113). The 30-day mortality was 10.7 % in PEG and 5.1 % in PRG ( P = 0.481 after multivariate logistic regression) CVA was associated with higher 30-day mortality, whereas ALS, higher body weight, and prophylactic placements in HNC were associated with lower rates. Tube-related complications were less frequent in PEG, both early (2.7 % vs. 26.4 %, P ≤ 0.001) and late (8.6 % vs. 31.5 %, P ≤ 0.001). The percentage of major complications and infections did not differ. Conclusions With respect to procedure-related and 30-day mortality, PEG and PRG compare equally. PRG had a higher procedural success rate. Tube-related complications and pain are less frequent after PEG compared to PRG. The choice for either PEG or PRG therefore should primarily be based on local facilities and expertise.
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Affiliation(s)
- Denise Strijbos
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands,Department of Gastroenterology and Hepatology, Catharina Hospital Eindhoven, The Netherlands,Corresponding author Denise Strijbos Maastricht University Medical CenterP. Debyelaan 25, 6229 HXMaastrichtthe Netherlands+31(0)402399751
| | - Daniel Keszthelyi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Lennard P. L. Gilissen
- Department of Gastroenterology and Hepatology, Catharina Hospital Eindhoven, The Netherlands
| | - Martin Lacko
- Department of Otorhinolaryngology/Head & Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | | | - Rogier J. J. de Ridder
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Michiel W. de Haan
- Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Ad A. M. Masclee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
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Rowell NP. Tumor implantation following percutaneous endoscopic gastrostomy insertion for head and neck and oesophageal cancer: Review of the literature. Head Neck 2019; 41:2007-2015. [PMID: 30684284 DOI: 10.1002/hed.25652] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 12/18/2018] [Accepted: 12/28/2018] [Indexed: 01/14/2023] Open
Abstract
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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Affiliation(s)
- Nicholas P Rowell
- Clinical Oncology, Kent Oncology Centre, Maidstone Hospital, Maidstone, Kent, United Kingdom
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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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Currie BM, Getrajdman GI, Covey AM, Alago W, Erinjeri JP, Maybody M, Boas FE. Push versus pull gastrostomy in cancer patients: A single center retrospective analysis of complications and technical success rates. Diagn Interv Imaging 2018; 99:547-553. [PMID: 29716845 DOI: 10.1016/j.diii.2018.04.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 04/12/2018] [Accepted: 04/12/2018] [Indexed: 12/11/2022]
Abstract
PURPOSE To compare the technical success and complication rates of push versus pull gastrostomy tubes in cancer patients, and to examine their dependence on operator experience. MATERIALS AND METHODS A retrospective review was performed of 304 cancer patients (170 men, 134 women; mean age 60.3±12.6 [SD], range: 19-102 years) referred for primary gastrostomy tube placement, 88 (29%) of whom had a previously unsuccessful attempt at percutaneous endoscopic gastrostomy (PEG) placement. Analyzed variables included method of insertion (push versus pull), indication for gastrostomy, technical success, operator experience, and procedure-related complications within 30 days of placement. RESULTS Gastrostomy tubes were placed for feeding in 189 patients and palliative decompression in 115 patients. Technical success was 91%: 78% after endoscopy had previously been unsuccessful and 97% when excluding failures associated with prior endoscopy. In the first 30 days, there were 29 minor complications (17.2%) associated with push gastrostomies, and only 8 minor complications (7.5%) with pull gastrostomies (P<0.05). There was no significant difference in major complications (push gastrostomy 5.3%, pull gastrostomy 5.6%). For decompressive gastrostomy tubes, the pull technique resulted in lower rates of both minor and major complications. There was no difference in complications or technical success rates for more versus less experienced operators. CONCLUSION Pull gastrostomy tube placement had a lower rate of complications than push gastrostomy tube placement, especially when the indication was decompression. The technical success rate was high, even after a failed attempt at endoscopic placement. Both the rates of success and complications were independent of operator experience.
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Affiliation(s)
- B M Currie
- Interventional Radiology, Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275, York avenue, New York, NY 10065, United States; Department of Radiology, Hospital of the University of Pennsylvania, 3400, Spruce Street, Philadelphia, PA 19104, United States
| | - G I Getrajdman
- Interventional Radiology, Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275, York avenue, New York, NY 10065, United States
| | - A M Covey
- Interventional Radiology, Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275, York avenue, New York, NY 10065, United States
| | - W Alago
- Interventional Radiology, Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275, York avenue, New York, NY 10065, United States
| | - J P Erinjeri
- Interventional Radiology, Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275, York avenue, New York, NY 10065, United States
| | - M Maybody
- Interventional Radiology, Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275, York avenue, New York, NY 10065, United States
| | - F E Boas
- Interventional Radiology, Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275, York avenue, New York, NY 10065, United States.
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Recurrence Due to Neoplastic Seeding in Head and Neck Cancer: Report of Two Cases and Review of the Literature. TUMORI JOURNAL 2018; 99:e144-7. [DOI: 10.1177/030089161309900421] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Aims and background Tumor progression due to seeding of tumor cells after definitive treatment for squamous cell carcinomas of the head and neck is an uncommon condition that can considerably worsen the outcome of patients with head and neck cancer. Methods and study design We report two cases of recurrence due to neoplastic seeding from oropharyngeal and oral cancer, respectively. We performed a literature review with MEDLINE as the main search engine. Results Seeding was found to occur most often in tracheotomy scars and gastrostomy sites. The oral cavity, hypopharynx and oropharynx were the primary sites in most cases, and advanced tumor stage seemed to be a risk factor for seeding. Treatment options include salvage surgery, which requires thorough resections, radiotherapy when possible, and palliative management. The prognosis of such events is poor. Conclusion Although neoplastic seeding is a well-known phenomenon in cancer surgery, many questions remain unanswered, especially regarding preventive measures and management strategies.
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Khaja SF, Schularick NM, Hoffman HT. Can technique used for gastrostomy tube placement reduce the risk of gastrostomy-site metastasis in head and neck cancer patients? Laryngoscope 2015; 125:2016-7. [DOI: 10.1002/lary.25188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 12/13/2014] [Accepted: 01/09/2015] [Indexed: 11/10/2022]
Affiliation(s)
- Sobia F. Khaja
- Department of Otolaryngology-Head and Neck Surgery; University of Iowa Hospitals and Clinic; 200 Hawkins Drive Iowa City Iowa U.S.A
| | - Nathan M. Schularick
- Department of Otolaryngology-Head and Neck Surgery; University of Iowa Hospitals and Clinic; 200 Hawkins Drive Iowa City Iowa U.S.A
| | - Henry T. Hoffman
- Department of Otolaryngology-Head and Neck Surgery; University of Iowa Hospitals and Clinic; 200 Hawkins Drive Iowa City Iowa U.S.A
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Diagnosis of Squamous Cell Carcinoma Metastasis With 18F-FDG PET/CT in Stoma After Percutaneous Endoscopic Gastrostomy. Clin Nucl Med 2014; 39:544-6. [DOI: 10.1097/rlu.0b013e3182a23cf6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Martin RCG, Cannon RM, Brown RE, Ellis SF, Williams S, Scoggins CR, Abbas AE. Evaluation of quality of life following placement of self-expanding plastic stents as a bridge to surgery in patients receiving neoadjuvant therapy for esophageal cancer. Oncologist 2014; 19:259-65. [PMID: 24567281 DOI: 10.1634/theoncologist.2013-0344] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
PURPOSE To determine whether self-expanding plastic stent (SEPS) placement significantly improves quality of life and maintains optimal nutrition while allowing full-dose neoadjuvant therapy (NAT) in patients with esophageal cancer. PATIENTS AND METHODS A prospective, dual-institution, single-arm, phase II (http://ClinicalTrials.gov: NCT00727376) evaluation of esophageal cancer patients undergoing NAT prior to resection. All patients had a self-expanding polymer stent placed prior to NAT. The European Organisation for Research and Treatment of Cancer QLQ-C30 and QLQ-OG25, Functional Assessment of Cancer Therapy-Anorexia, and Functional Assessment of Cancer Therapy-General surveys were administered prior to stenting, within 1 week post-stent placement, and at the completion of neoadjuvant therapy. RESULTS Fifty-two patients were enrolled; 3 (5.8%) had stent migrations requiring replacement. There were no instances of esophageal erosion or perforation. All patients received some form of neoadjuvant therapy. Thirty-six (69%) received chemoradiation; 34 (93%) of these patients received the planned dose of chemotherapy, and 27 (75%) received the full planned dose of radiotherapy. There were 16 (31%) patients receiving chemotherapy alone; 12 (74%) of patients in the chemotherapy-alone group completed the planned dose of therapy. CONCLUSION Placement of SEPS appears to provide significant improvement in quality of life related to dysphagia and eating restriction in patients with esophageal cancer undergoing neoadjuvant therapy. Consideration of SEPS instead of percutaneous feeding tube should be initiated as a first line in dysphagia palliation and NAT nutritional support.
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Affiliation(s)
- Robert C G Martin
- University of Louisville, Department of Surgery, Division of Surgical Oncology, Louisville, Kentucky, USA; Department of Surgery, Ochsner Medical Center, Ochsner Health Systems, New Orleans, Louisiana, USA
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McAllister P, MacIver C, Wales C, McMahon J, Devine J, McHattie G, Makubate B. Gastrostomy insertion in head and neck cancer patients: a 3 year review of insertion method and complication rates. Br J Oral Maxillofac Surg 2013; 51:714-8. [DOI: 10.1016/j.bjoms.2013.07.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 07/17/2013] [Indexed: 10/26/2022]
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Alshadwi A, Nadershah M, Carlson ER, Young LS, Burke PA, Daley BJ. Nutritional Considerations for Head and Neck Cancer Patients: A Review of the Literature. J Oral Maxillofac Surg 2013; 71:1853-60. [DOI: 10.1016/j.joms.2013.04.028] [Citation(s) in RCA: 105] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2013] [Revised: 04/22/2013] [Accepted: 04/25/2013] [Indexed: 12/11/2022]
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Teh JL, Wong RK, Gowans M, Shabbir A, Doshi B, Ong DE, Fan VT. Gastric metastases of oral carcinoma resulting from percutaneous endoscopic gastrostomy placement via the introducer technique. Gastroenterol Rep (Oxf) 2013; 1:211-3. [PMID: 24759969 PMCID: PMC3937992 DOI: 10.1093/gastro/got027] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION. Tumour cell implantation is a rare complication in patients with head and neck cancers, who have undergone percutaneous endoscopic gastrostomy (PEG) tube placement. It has not been reported in patients who underwent a PEG insertion via the radiological or introducer technique. We describe a novel case presentation of metastatic disease in a patient who underwent PEG placement via the introducer (Russell) technique which, to the best of our knowledge, has not not previously been described. CASE PRESENTATION. The patient was a 37-year-old Malay woman who developed metastatic squamous cell carcinoma deposits in her stomach and liver one month after a gastrostomy tube was removed following the completion of treatment for oropharyngeal carcinoma. CONCLUSION. Previous authors have advocated the use of alternative PEG insertion technique apart from the 'pull' technique to minimise the risk of tumour implantation from head and neck cancers. Our case report suggests that this risk is not totally eliminated when the PEG tube is inserted via the introducer technique.
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Affiliation(s)
- Jun Liang Teh
- Division of General Surgery, National University Hospital, Singapore, Division of Gastroenterology & Hepatology, National University Hospital, Singapore and Department of Oral and Maxillofacial Surgery, National University Hospital, Singapore
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Kibriya N, Wilbraham L, Mullan D, Puro P, Vasileuskaya S, Edwards DW, Laasch HU. Disc-retained tubes for radiologically inserted gastrostomy (RIG): not up to the job? Clin Radiol 2013; 68:1128-32. [PMID: 23942264 DOI: 10.1016/j.crad.2013.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Revised: 06/09/2013] [Accepted: 06/14/2013] [Indexed: 10/26/2022]
Abstract
AIM To assess the insertion procedure and performance of disc-retained gastrostomy tubes, recording complications and accidental displacements by prospective audit, and to determine whether primary placement of the tube off-licence was feasible. MATERIALS AND METHODS Disc-retained 12 F single-lumen Monarch gastrostomy tubes (Enteral UK, Selby, UK) were inserted by three gastrointestinal interventional radiologists in a supra-regional cancer centre. The 12 F tubes required a 20 F peel-away sheath with four-point gastropexy fixation and were placed under conscious sedation, using electrocardiogram (EEG) bispectral index monitoring. Follow-up was performed in an in-house gastrostomy drop-in clinic at 1 week and 1 month, supplemented with weekly telephone follow-up. Patients also had open access to the gastrostomy drop-in clinic for immediate advice and complication management. RESULTS Eighteen patients underwent primary insertion of a Monarch gastrostomy tube over 5 months. A total of 6/18 (33%) tubes displaced; 4/18 (22%) completely, 2/18 (11%) occult into the peritoneum. Four of 18 (22%) patients developed infection at the stoma site. Due to the unexpectedly poor performance of the tube, the study was terminated early. CONCLUSION Initial experience with the Monarch disc-retained gastrostomy tube demonstrates it unsuitable for primary placement with current protocols. In view of the potentially serious complications, the Medicines and Healthcare Products Regulatory Agency (MHRA) has been informed. A request has been made to the distributer to reassess the tube design and/or review the procedure promoted for primary placement.
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Affiliation(s)
- N Kibriya
- Department of Radiology, The Christie NHS Foundation Trust, Manchester M20 4BX, UK.
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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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Mallinson P, Tun JK, Byass O, Cast J. Usage of prophylactic radiologically inserted gastrostomy in head and neck cancer patients. Clin Radiol 2012; 67:1175-8. [DOI: 10.1016/j.crad.2012.04.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2012] [Revised: 04/15/2012] [Accepted: 04/20/2012] [Indexed: 11/28/2022]
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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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Multicentre survey of radiologically inserted gastrostomy feeding tube (RIG) in the UK. Clin Radiol 2012; 67:843-54. [DOI: 10.1016/j.crad.2012.01.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Revised: 12/30/2011] [Accepted: 01/09/2012] [Indexed: 12/14/2022]
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Sinapi I, Navez B, Hamoir M, Schmitz S, Machiels JP, Deprez PH, Van den Eynde M. Seeding of the percutaneous endoscopic gastrostomy site from head and neck carcinoma: Case report and review of the literature. Head Neck 2012; 35:E209-12. [DOI: 10.1002/hed.23015] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2012] [Indexed: 11/06/2022] Open
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Locher JL, Bonner JA, Carroll WR, Caudell JJ, Keith JN, Kilgore ML, Ritchie CS, Roth DL, Tajeu GS, Allison JJ. Prophylactic percutaneous endoscopic gastrostomy tube placement in treatment of head and neck cancer: a comprehensive review and call for evidence-based medicine. JPEN J Parenter Enteral Nutr 2011; 35:365-74. [PMID: 21527598 DOI: 10.1177/0148607110377097] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Patients with head and neck cancers (HNCs) are at increased risk of experiencing malnutrition, which is associated with poor outcomes. Advances in the treatment of HNCs have resulted in improved outcomes that are associated with severe toxic oral side effects, placing patients at an even greater risk of malnutrition. Prophylactic placement of percutaneous endoscopic gastrostomy (PEG) tubes before treatment may be beneficial in patients with HNC, especially those undergoing more intense treatment regimens. PEG tube placement, however, is not without risks. METHODS A comprehensive review of the literature was conducted. RESULTS Systematic evidence assessing both the benefits and harm associated with prophylactic PEG tube placement in patients undergoing treatment for HNC is weak, and benefits and harm have not been established. CONCLUSIONS More research is necessary to inform physician behavior on whether prophylactic PEG tube placement is warranted in the treatment of HNC.
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Affiliation(s)
- Julie L Locher
- Department of Medicine, Division of Gerontology, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Brown RE, Abbas AE, Ellis S, Williams S, Scoggins CR, McMasters KM, Martin RC. A Prospective Phase II Evaluation of Esophageal Stenting for Neoadjuvant Therapy for Esophageal Cancer: Optimal Performance and Surgical Safety. J Am Coll Surg 2011; 212:582-8; discussion 588-9. [DOI: 10.1016/j.jamcollsurg.2010.12.026] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Accepted: 12/15/2010] [Indexed: 01/24/2023]
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Madhoun MF, Blankenship MM, Blankenship DM, Krempl GA, Tierney WM. Prophylactic PEG placement in head and neck cancer: How many feeding tubes are unused (and unnecessary)? World J Gastroenterol 2011; 17:1004-8. [PMID: 21448351 PMCID: PMC3057142 DOI: 10.3748/wjg.v17.i8.1004] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2010] [Revised: 04/15/2010] [Accepted: 04/22/2010] [Indexed: 02/06/2023] Open
Abstract
AIM: To determine the rate of use and non-use of prophylactic percutaneous endoscopic gastrostomy (PEG) tubes among patients with head and neck cancer (HNC) patients.
METHODS: All patients with HNC undergoing PEG between January 1, 2004 and June 30, 2006 were identified. Patients (or their next-of-kin) were surveyed by phone and all available medical records and cancer registry data were reviewed. Prophylactic PEG was defined as placement in the absence of dysphagia and prior to radiation or chemoradiation. Each patient with a prophylactic PEG was assessed for cancer diagnosis, type of therapy, PEG use, and complications related to PEG.
RESULTS: One hundred and three patients had PEG tubes placed for HNC. Thirty four patients (33%) could not be contacted for follow-up. Of the 23 (22.3%) patients with prophylactic PEG tubes, 11/23 (47.8%) either never used the PEG or used it for less than 2 wk. No association with PEG use vs non-use was observed for cancer diagnosis, stage, or specific cancer treatment. Non-use or limited use was observed in 3/6 (50%) treated with radiation alone vs 8/17 (47.1%) treated with chemoradiation (P = 1.0), and 3 of 10 (30%) treated with surgery vs 8 of 13 (62%) not treated with surgery (P = 0.21). Minor complications were reported in 5/23 (21.7%). One (4.3%) major complication was reported.
CONCLUSION: There is a high rate of unnecessary PEG placement when done prophylactically in patients with head and neck cancer.
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Grant DG, Bradley PT, Pothier DD, Bailey D, Caldera S, Baldwin DL, Birchall MA. Complications following gastrostomy tube insertion in patients with head and neck cancer: a prospective multi-institution study, systematic review and meta-analysis. Clin Otolaryngol 2009; 34:103-12. [PMID: 19413607 DOI: 10.1111/j.1749-4486.2009.01889.x] [Citation(s) in RCA: 155] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To measure morbidity and mortality rates following insertion of gastrostomy tubes in head and neck cancer patients. To determine evidence for any relationship between gastrostomy insertion technique and complication rates. DESIGN A prospective cohort study and qualitative systematic review. SETTING Multi-cancer networks in the South West of England, Hampshire and the Isle of White. PARTICIPANTS One hundred and seventy-two patients with head and neck cancer undergoing gastrostomy tube insertion between 2004 and 2005. Percutaneous endoscopic gastrostomy (PEG) was performed in 121 patients. Fifty-one patients had radiologically inserted gastrostomy (RIG). Twenty-seven studies reporting outcomes following 2353 gastrostomy procedures for head and neck cancer. MAIN OUTCOME MEASURES Post-procedure mortality, major and minor complications. RESULTS In the present series, mortality rates were 1.0% (1/121) for PEG and 3.9% (2/51) for RIG. Overall major complication rates following PEG and RIG were 3.3% (4/121) and 15.6% (9/51) respectively. In our systematic review and meta-analysis of 2379 head and neck cancer patients, we observed fatality rates of 2.2% (95% CI 0.014-0.034) following PEG and 1.8% (95% CI 0.010-0.032) following RIG. Furthermore, major complication rates following PEG were 7.4% (95% CI 5.9-9.3%) and 8.9% (95% CI 7.0-11.2%) after RIG. CONCLUSIONS Procedure related mortality rates following gastrostomy in head and neck cancer patients are higher than those in mixed patient populations. Major complication rates following RIG in head and neck cancer patients are greater than those following PEG. Major complications following PEG in patients with head and neck cancer appear no worse than in mixed pathology groups. We have identified that RIG is associated with increased morbidity and mortality in patients who are ineligible for PEG. The serious nature of the complications associated with gastrostomy particularly in patients with head and neck cancer requires careful consideration by the referring physician.
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Affiliation(s)
- D G Grant
- Department of Otolaryngology, Head and Neck Surgery, Southmead Hospital, Bristol, UK.
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Oakley RJ, Donnelly R, Freeman L, Wong T, McCarthy M, Calman F, O'Connell M, Jeannon JP, Simo R. An audit of percutaneous endoscopic gastrostomy insertion in patients undergoing treatment for head and neck cancer: reducing the incidence of peri-operative airway events by the introduction of a tumour assessment protocol. Ann R Coll Surg Engl 2009; 91:249-54. [PMID: 19220948 DOI: 10.1308/003588409x391857] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION The presence of a malignancy of the upper aerodigestive tract introduces the potential for iatrogenic complications additional to those usually associated with percutaneous endoscopic gastrostomy. Specifically, seeding of tumour from the upper aerodigestive tract creating abdominal wall metastases, and airway obstruction due to tumour directly occluding the airway when a patient is sedated for percutaneous endoscopic gastrostomy. PATIENTS AND METHODS We report an audit of our experience of gastrostomy placement for patients under going treatment for head and neck cancer in our institution from September 2003 to October 2006. RESULTS Of 33 patients who had percutaneous endoscopic gastrostomy insertion under sedation in the first cycle of the audit, two (6%) experienced major airway complications resulting in one fatality. A tumour assessment protocol was introduced. In the second cycle, 96 patients had percutaneous endoscopic gastrostomies, of whom 16 (13%) underwent gastrostomy insertion under general anaesthetic and five (4.5%) under radiological guidance. No patients had airway complications or abdominal wall metastases. CONCLUSIONS A formal tumour assessment protocol eliminated airway obstruction as a complication of percutaneous endoscopic gastrostomy insertion and may reduce the potential for abdominal wall metastases at the gastrostomy site when using the pull technique.
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Affiliation(s)
- Richard J Oakley
- Department of Otolaryngology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
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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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