Dipartimento di Scienze Mediche e Chirurgiche, Policlinico Universitario Fondazione Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
Dipartimento di Scienze dell'Invecchiamento, Neurologiche, Ortopediche e della Testa-Collo, Policlinico Universitario Fondazione Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
JPEN J Parenter Enteral Nutr. 2022 Aug;46(6):1258-1269. doi: 10.1002/jpen.2360. Epub 2022 May 22.
Patients with head and neck cancer (HNC) are frequently malnourished at the time of diagnosis and before beginning treatment. In addition, chemoradiotherapy causes or exacerbates symptoms such as alteration or loss of taste, mucositis, xerostomia, fatigue, nausea, and vomiting, with consequent worsening of malnutrition. If obstructing cancer and/or mucositis interferes with swallowing, enteral nutrition should be delivered by a nasogastric tube (NGT) or percutaneous endoscopic gastrostomy (PEG). To review studies comparing NGT's and PEG's nutrition outcomes, survival, hospitalizations, radiotherapy interruptions, quality of life, and swallowing function. Two hundred fifty publications were identified via electronic databases. 26 manuscripts that met the inclusion criteria were included for analysis. We divided the analysis in two sections: (1) comparison of enteral nutrition through NGT or PEG and (2) comparison of reactive PEG (R-PEG) and prophylactic PEG (P-PEG). They have comparable nutrition outcomes, number of radiotherapy interruptions, survival, and quality of life, whereas swallow function seems better with NGT. PEG may be associated with major complications such as exit-site infection, malfunction, leakage, pain, pulmonary infection, and higher costs. Nevertheless, NGTs dislodged more often; patients find NGTs more inconvenient; NGTs may cause aspiration pneumonia; P-PEG and R-PEG have similar nutrition outcomes, number of radiotherapy interruptions, and survival. PEG does not have better nutrition, oncologic, and quality-of-life outcomes than NGT. Prophylactic feeding through NGT or PEG, compared with reactive feeding, does not offer significant advantages in nutrition outcomes, radiotherapy interruptions, and survival. However, the number of prospective randomized studies on this topic is limited; consequently, definitive conclusions cannot be drawn. Further adequate, prospective randomized studies are needed.
头颈部癌症（HNC）患者在诊断时和开始治疗前经常营养不良。此外，放化疗会引起或加重味觉改变或丧失、黏膜炎、口干、疲劳、恶心和呕吐等症状，从而导致营养不良恶化。如果阻塞性癌症和/或黏膜炎干扰吞咽，应通过鼻胃管（NGT）或经皮内镜胃造口术（PEG）进行肠内营养。回顾比较 NGT 和 PEG 营养结局、生存、住院、放疗中断、生活质量和吞咽功能的研究。通过电子数据库确定了 250 篇出版物。有 26 篇符合纳入标准的手稿被纳入分析。我们将分析分为两部分：（1）通过 NGT 或 PEG 进行肠内营养的比较，（2）反应性 PEG（R-PEG）和预防性 PEG（P-PEG）的比较。它们具有可比的营养结局、放疗中断次数、生存和生活质量，而 NGT 似乎对吞咽功能更好。PEG 可能与出口部位感染、故障、渗漏、疼痛、肺部感染和更高的成本等主要并发症相关。尽管如此，NGT 更频繁地移位；患者发现 NGT 更不方便；NGT 可能导致吸入性肺炎；P-PEG 和 R-PEG 具有相似的营养结局、放疗中断次数和生存。PEG 在营养、肿瘤和生活质量方面的结局并不优于 NGT。与反应性喂养相比，通过 NGT 或 PEG 进行预防性喂养在营养结局、放疗中断和生存方面没有显著优势。然而，关于这个主题的前瞻性随机研究数量有限；因此，不能得出明确的结论。需要进一步进行充分的、前瞻性的随机研究。
