Metkus James S, Cognetti David, Curry Joseph
Department of Otolaryngology Thomas Jefferson University Philadelphia Pennsylvania.
Laryngoscope Investig Otolaryngol. 2017 Nov 22;2(6):395-397. doi: 10.1002/lio2.127. eCollection 2017 Dec.
Head and neck cancer (HNC) patients often require percutaneous gastrostomy (PEG) tube placement due to malnutrition and dysphagia. While beneficial, PEG tube placement can cause a rare but reportable complication of metastasis of the original tumor to the gastrostomy exit site. The objectives of this case series were to present HNC patients at a single institution that developed PEG tube metastases, their subsequent treatment, and review of the literature for similar cases.
We describe three HNC patients who underwent PEG tube placement and developed metastasis at their tube site. We also describe their metastatic disease treatment and compare these cases with similar cases in the literature.
All three cases' initial staging were node positive and all three cases had their PEG tubes placed by the "pull" method. Two patients presented with masses at their PEG site while one patient had a site mass on surveillance positron emission topography (PET) imaging. Biopsy showed the original HNC metastasized to the gastrostomy site. Two patients were treated with surgical resection while one patient was treated with palliative chemotherapy. The "pull" method has been most associated with cases of metastasis in the literature. In the literature, risk factors for metastasis include initial tumor clinical and pathological staging.
PEG site metastasis should be suspected in patients with skin changes at the PEG site. "Pull" procedures may cause metastasis through physical contact with the primary tumor causing tumor seeding at the PEG site. Surgical resection of metastasis has been shown to be an effective treatment strategy for PEG site metastasis. In patients with higher stage cancers, tube insertion methods that avoid contact with the primary tumor should be considered.
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头颈部癌（HNC）患者常因营养不良和吞咽困难而需要放置经皮胃造口术（PEG）管。虽然PEG管放置有益，但可能会导致一种罕见但可报告的并发症，即原发肿瘤转移至胃造口出口部位。本病例系列的目的是介绍在单一机构发生PEG管转移的HNC患者、他们随后的治疗情况，并对类似病例的文献进行综述。
我们描述了3例接受PEG管放置并在管部位发生转移的HNC患者。我们还描述了他们转移性疾病的治疗情况，并将这些病例与文献中的类似病例进行比较。
所有3例患者的初始分期均为淋巴结阳性，且所有3例患者的PEG管均通过“牵拉”法放置。2例患者在PEG部位出现肿块，而1例患者在监测正电子发射断层扫描（PET）成像时发现部位肿块。活检显示原发HNC转移至胃造口部位。2例患者接受了手术切除，而1例患者接受了姑息化疗。在文献中，“牵拉”法与转移病例的关联最为密切。在文献中，转移的危险因素包括初始肿瘤的临床和病理分期。
对于PEG部位皮肤有变化的患者，应怀疑发生了PEG部位转移。“牵拉”操作可能通过与原发肿瘤的物理接触导致肿瘤细胞在PEG部位播种，从而引起转移。已证明手术切除转移灶是治疗PEG部位转移的有效策略。对于癌症分期较高的患者，应考虑采用避免与原发肿瘤接触的置管方法。
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