Incidence of abdominal wall metastasis complicating PEG tube placement in untreated head and neck cancer.

BACKGROUND

Abdominal wall metastasis after PEG tube placement has been reported in patients with head and neck cancer. The incidence of this occurrence is unknown.

OBJECTIVE

Evaluation of the incidence of abdominal wall metastasis as a complication of PEG tube placement in patients with head and neck cancer.

DESIGN

Retrospective chart review.

SETTING

H. Lee Moffitt Cancer Center and Research Institute, Nutritional Support Services.

SUBJECTS: Head and neck cancer patients requiring nutritional support with PEG tube placement.

RESULTS

Of the 304 patients with head and neck cancer, 218 had active disease with a viable tumor in the oropharynx or hypopharynx at the time of PEG placement. Two of these patients, both with active disease (0.92%), developed a PEG site metastasis.

CONCLUSION

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. 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. Use of other percutaneous techniques that do not involve traversing the hypopharynx with the catheter may help to prevent tumor translocation. When head and neck cancers metastasize to the gastrostomy site, patient survival appears limited even with extensive resection.