Metastasis to the Percutaneous Endoscopic Gastrostomy Site in the Patient With Head and Neck Cancer: A Case Report and Review of the Literature

Abstract

Significant advances in the surgical and adjuvant care of patients with head and neck cancer have led to marked improvements in outcomes over the past 2 decades and have significantly improved postoperative quality of life. These advances are due, in part, to modifications of operative techniques, improved supportive care, and continuous ongoing efforts to reduce the incidence of even rare complications. Increasingly, the oral and maxillofacial surgeon is taking the central role in all treatment decisions of these patients. Patients with head and neck malignancy are often chronically malnourished and/or catabolic, with a negative nitrogen balance, and therefore early and sustained adequate nutritional management is an important consideration for these patients. Supplemental (preferably enteral) feeding is frequently needed on a temporary or permanent basis. For that purpose, nasogastric tubes are often not well tolerated for more than brief periods of time and open gastrostomy procedures can be associated with a significant recovery period and complication rates. The less invasive method of percutaneous endoscopic gastrostomy (PEG) was introduced in 1980, and has since become the standard for enteral feeding access placement in most patients with head and neck cancer. The PEG may be placed at the time of initial evaluation (triple endoscopy) before potential resection or chemo-radiation therapy or after resection, in an immediate or delayed fashion. The latter approach may prove more difficult because of changed anatomy and potential disruption of fresh suture lines. This review represents a case analysis of tumor implantation into the abdominal wall after PEG placement, before resection of the primary tumor, and the second such report in the oral and maxillofacial literature. We will review the literature of this rare complication, provide insights into potential pathogenesis, and discuss strategies to minimize this complication in the future.