Garcia Joana Lemos, Rodrigues Rita Vale, Mão-de-Ferro Susana, Ferreira Sara, Serrano Miguel, Castela Joana, Sacarrão Raquel, Francisco Fátima, Sousa Liliana, Dias Pereira António
Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal.
GE Port J Gastroenterol. 2022 Aug 30;30(5):350-358. doi: 10.1159/000525853. eCollection 2023 Oct.
Oesophageal cancer causes dysphagia and weight loss. Malnutrition further worsens with multimodal treatment.
The aim of the study was to evaluate the impact of percutaneous endoscopic gastrostomy (PEG) placement in the nutritional status of patients with oesophageal cancer requiring chemoradiotherapy (CRT).
A comparative study with a prospective arm and a historical cohort was conducted. Oesophageal cancer patients undergoing CRT with dysphagia grade >2 and/or weight loss >10% were submitted to PEG-tube placement (pull method) before CRT. Stoma seeding was evaluated through a swab obtained after placement and, in surgical patients, the resected stoma. A matched historical cohort without PEG placement was used as control (trial ACTRN12616000697482).
Twenty-nine patients (intervention group, IG) were compared to 30 patients (control group, CG). Main outcomes did not differ in the IG and CG: weight loss during CRT 8.1 ± 5.5 kg versus 9.1 ± 4.2 kg ( = 0.503); 6-month mortality after CRT or surgery 17.2% versus 26.7% ( = 0.383); perioperative complication rate 54.5% versus 55.6% ( = 1.000); unplanned hospital admissions 34.5% versus 40.0% ( = 0.661). In the CG, during CRT, 14 (46.7%) patients presented with dysphagia grade 3-4, of whom 12 required nasogastric tube feeding ( = 10), surgical gastrostomy ( = 1), and oesophageal dilation ( = 1). In the IG, 89.7% used the PEG tube during CRT, sometimes exclusively in 51.7%. Adverse events were mainly minor ( = 12, 41.4%), mostly late peristomal infections, 1 major complication (exploratory laparotomy due to suspected colonic interposition, not confirmed). There was no cytological or histological evidence of stomal tumour seeding.
Weight loss, hospital admissions, surgical complications, and mortality were identical in oesophageal cancer patients referred for CRT, regardless of prophylactic PEG. However, half of the patients required exclusive enteral nutritional support, making PEG-tube placement an alternative to consider.
食管癌会导致吞咽困难和体重减轻。多模式治疗会使营养不良进一步恶化。
本研究旨在评估经皮内镜下胃造口术（PEG）置入对需要放化疗（CRT）的食管癌患者营养状况的影响。
进行了一项包含前瞻性队列和历史队列的对比研究。吞咽困难分级>2级和/或体重减轻>10%的接受CRT的食管癌患者在CRT前接受PEG管置入（牵拉法）。通过置入后获取的拭子评估造口种植情况，对于接受手术的患者，则评估切除的造口。将未进行PEG置入的匹配历史队列作为对照（试验ACTRN12616000697482）。
将29例患者（干预组，IG）与30例患者（对照组，CG）进行比较。IG组和CG组的主要结局无差异：CRT期间体重减轻分别为8.1±5.5kg和9.1±4.2kg（P = 0.503）；CRT或手术后6个月死亡率分别为17.2%和26.7%（P = 0.383）；围手术期并发症发生率分别为54.5%和55.6%（P = 1.000）；非计划住院率分别为34.5%和40.0%（P = 0.661）。在CG组中，CRT期间，14例（46.7%）患者出现3 - 4级吞咽困难，其中12例需要鼻胃管喂养（n = 10）、手术胃造口术（n = 1）和食管扩张术（n = 1）。在IG组中，89.7%的患者在CRT期间使用了PEG管，有时仅51.7%的患者单独使用。不良事件主要为轻微事件（n = 12，41.4%），大多为晚期造口周围感染，1例严重并发症（因疑似结肠内疝行剖腹探查术，未得到证实）。没有细胞学或组织学证据表明造口有肿瘤种植。
接受CRT的食管癌患者，无论是否进行预防性PEG置入，体重减轻、住院情况、手术并发症和死亡率均相同。然而，一半的患者需要完全肠内营养支持，这使得PEG管置入成为一个可供考虑的选择。
