Gastrostomy tube for nutrition and bowel obstruction in patients with advanced malignancy: Less is more.

Abstract

700 Background: Malnutrition and malignant bowel obstruction (MBO) are common consequences of advanced malignancy. Both lead to a poor prognosis, frequent hospitalizations, and have a negative impact on quality of life. The aim of this study is to explore gastrostomy tube (g-tube) placement practices to better define the role of g-tube role in advanced malignancy. Methods: Patients who underwent g-tube placement at our tertiary cancer care center between 2013 and 2017 were included in this study. Patients’ demographics, diagnosis, procedures, postoperative course, and clinical data were collected. Complications and survival were used as endpoints. Results: Two hundred forty-two cancer patients with an average age at diagnosis of 61 years (range 21-94) underwent g-tube placement for nutrition (76.4%), decompression (MBO) (22.7%), or both (0.8%). Active treatment within 3 months of g-tube insertion was seen in 37.8% of the nutrition group versus 29.1% in the MBO group (p = 0.208). Successful insertion was achieved in 96.8% of patients, but nine patients required more than one method of insertion attempt. In the nutrition group, successful method of insertion was 88.1% in interventional radiology, 8.1% in operating room, and 3.8% in endoscopy suite, compared to 81.8%, 14.5%, and 3.6% for the MBO group, respectively (p = 0.426). Post-placement complications were significantly less common in the MBO group compared to the nutrition group (24.1 vs. 54.3%, p < 0.001). Consultation pattern in the MBO group revealed that 45.5% had a palliative care consult, 56.4% were seen by social work, and 47.3% went to hospice. Survival in the MBO group was significantly shorter than in the nutrition group at 30 days (52.7 vs. 90.3%, p < 0.001), 1-year (54.6 vs. 5.9%, p<0.001), and three years (24.1 vs 1.8%, p = 0.001) after g-tube placement. Conclusions: In our experience, most patients who undergo g-tube insertion are not receiving active treatment and a large proportion of patients who receive a decompressive g-tube have a life expectancy of less than a month. These findings will inform the next step of our study: creating a discussion tool to coordinate better care and interventional decision making for patients with advanced malignancy.