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Metastatic head and neck carcinoma to a percutaneous endoscopic gastrostomy site.
Head Neck. 2005 Apr; 27(4):339-43.HN

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.

Authors+Show Affiliations

Department of Otolaryngology-Head and Neck Surgery at the University of Texas Southwestern Medical Center in Dallas, Texas, USA.No affiliation info available

Pub Type(s)

Case Reports
Journal Article
Review

Language

eng

PubMed ID

15712297

Citation

Adelson, Robert Todd, and Yadranko Ducic. "Metastatic Head and Neck Carcinoma to a Percutaneous Endoscopic Gastrostomy Site." Head & Neck, vol. 27, no. 4, 2005, pp. 339-43.
Adelson RT, Ducic Y. Metastatic head and neck carcinoma to a percutaneous endoscopic gastrostomy site. Head Neck. 2005;27(4):339-43.
Adelson, R. T., & Ducic, Y. (2005). Metastatic head and neck carcinoma to a percutaneous endoscopic gastrostomy site. Head & Neck, 27(4), 339-43.
Adelson RT, Ducic Y. Metastatic Head and Neck Carcinoma to a Percutaneous Endoscopic Gastrostomy Site. Head Neck. 2005;27(4):339-43. PubMed PMID: 15712297.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Metastatic head and neck carcinoma to a percutaneous endoscopic gastrostomy site. AU - Adelson,Robert Todd, AU - Ducic,Yadranko, PY - 2005/2/16/pubmed PY - 2005/7/15/medline PY - 2005/2/16/entrez SP - 339 EP - 43 JF - Head & neck JO - Head Neck VL - 27 IS - 4 N2 - 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. SN - 1043-3074 UR - https://www.unboundmedicine.com/medline/citation/15712297/Metastatic_head_and_neck_carcinoma_to_a_percutaneous_endoscopic_gastrostomy_site_ L2 - https://doi.org/10.1002/hed.20159 DB - PRIME DP - Unbound Medicine ER -