4736 Percutaneous endoscopic gastrostomy and tumor seeding: an emerging complication of the pull technique in patients with head and neck cancer.

The use of percutaneous endoscopic gastrostomy (PEG) tube for enteral feeding has gained wide acceptance in various clinical settings. Head and neck cancer (HN H&NC and non H&NC.We looked specifically for the complication of tumor seeding at the site of PEG tube placement. Results: 330 cancer patients had PEG tube placed during the period of study using the pull technique. 248 patients had H&NC, mean age 66.5 (39-85) years, male/female ratio was 167/81. The non H&NC were 82 patients, mean age 64 (17-88) years, male/female ratio was 55/27. None of the non H&NC patients had tumor seeding and only two patients with H&NC had tumor seeding at the PEG exit site. The first patient was a 58-year-old man with a history of invasive squamous cell carcinoma (SCC) of the right maxillary sinus involving the palate. Following surgical resection a PEG tube was placed. Fourteen weeks later he presented with a mass around the PEG tube exit. The mass was resected and the histology confirmed SCC. The second patient was a 48-year-old man with a history of SCC of the piriform sinus treated with preoperative chemoradiation. The patient underwent a PEG tube placement prior to surgery. Four months later he presented with a slowly growing granulation tissue with purulent discharge that did not respond to antibiotics and local silver nitrate therapy. A biopsy of the tissue confirmed SCC. The patient underwent endoscopy which showed a large submucosal mass. He underwent wide local excision of the abdominal wall with partial gastrectomy. Conclusions: Metastatic implantation of H&NC at the site of PEG tube is a newly emerging complication following the pull technique. We encounterd 2 patients among 248 H&NC patients (0.8%) who developed this complication. Both of our patients had viable tumor in the oropharyngeal cavity. We recommend careful assessment of the oropharynx prior to PEG tube placement to avoid tumor seeding. In patients with viable tumor in the oropharynx, alternative methods of tube placement should be considered.