Percutaneous gastrostomy site metastasis from head and neck tumors: A single institution case series.
Publication/Presentation Date
12-1-2017
Abstract
OBJECTIVES: Head and neck cancer (HNC) patients often require percutaneous gastrostomy (PEG) tube placement due to malnutrition and dysphagia. While beneficial, PEG tube placement can cause a rare but reportable complication of metastasis of the original tumor to the gastrostomy exit site. The objectives of this case series were to present HNC patients at a single institution that developed PEG tube metastases, their subsequent treatment, and review of the literature for similar cases.
METHODS: We describe three HNC patients who underwent PEG tube placement and developed metastasis at their tube site. We also describe their metastatic disease treatment and compare these cases with similar cases in the literature.
RESULTS: All three cases' initial staging were node positive and all three cases had their PEG tubes placed by the "pull" method. Two patients presented with masses at their PEG site while one patient had a site mass on surveillance positron emission topography (PET) imaging. Biopsy showed the original HNC metastasized to the gastrostomy site. Two patients were treated with surgical resection while one patient was treated with palliative chemotherapy. The "pull" method has been most associated with cases of metastasis in the literature. In the literature, risk factors for metastasis include initial tumor clinical and pathological staging.
CONCLUSION: PEG site metastasis should be suspected in patients with skin changes at the PEG site. "Pull" procedures may cause metastasis through physical contact with the primary tumor causing tumor seeding at the PEG site. Surgical resection of metastasis has been shown to be an effective treatment strategy for PEG site metastasis. In patients with higher stage cancers, tube insertion methods that avoid contact with the primary tumor should be considered.
LEVEL OF EVIDENCE: NA.
Volume
2
Issue
6
First Page
395
Last Page
397
ISSN
2378-8038
Published In/Presented At
Metkus, J. S., Cognetti, D., & Curry, J. (2017). Percutaneous gastrostomy site metastasis from head and neck tumors: A single institution case series. Laryngoscope investigative otolaryngology, 2(6), 395–397. https://doi.org/10.1002/lio2.127
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
29299514
Department(s)
Administration and Leadership
Document Type
Article