Abstract
BackgroundPatients with aero-digestive malignancy will often require a feeding gastrostomy during their treatment to maintain their nutritional status. These are usually placed percutaneously using an endoscopic technique.Case presentationA fifty-six year old male underwent placement of a percutaneous gastrostomy (PEG) prior to commencement of his treatment for an oral squamous cell carcinoma. The treatment for this was locally curative. However, he developed a metastasis at the site of his PEG tube. This was excised en-bloc with the anterior gastric and abdominal walls.ConclusionTumour implantation into wounds has been previously reported. In this case the direct trauma of passing the PEG tube through the oropharynx led to implantation of cells in the anterior abdominal wall. In these cases laparoscopic placement may be more beneficial to avoid this problem.
Highlights
Patients with aero-digestive malignancy will often require a feeding gastrostomy during their treatment to maintain their nutritional status
Tumour implantation into wounds has been previously reported. In this case the direct trauma of passing the Percutaneous endoscopic gastrostomy (PEG) tube through the oropharynx led to implantation of cells in the anterior abdominal wall
We report a case of a patient who underwent PEG placement prior to surgery and adjuvant radiotherapy for a squamous carcinoma of the tongue
Summary
Patients with head and neck carcinoma usually have gastrostomy tubes placed prior to surgery but where the feeding tube is passed over the oropharynx, tumour cells may be carried on the tube and directly implanted into the abdominal wall. In view of the fact that this is at least the sixteenth report of port-site recurrence it may be more appropriate to insert a feeding gastrostomy tube laparoscopically at the time of the head and neck surgery. This simple minimally invasive technique overcomes the risk of implantation of cancer cells during insertion of a conventional PEG. I would recommend this technique for insertion of a feeding gastrostomy tube in patients with head and neck cancer
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