title: Modest benefit of total parenteral nutrition and chemotherapy after venting gastrostomy tube placement.
abstract: OBJECTIVE
  The aim of the study is to review a single institution's experience with gastrostomy tubes (GTs) performed for malignant bowel obstruction from gynecologic cancers.
  
  
  METHODS
  Women with gynecologic cancers who underwent venting GT placement from 2000 to 2008 were identified and clinical data were extracted. Logistic regression and spearman correlational coefficients were used to determine relationships between variables. Survival analysis was performed using the Kaplan-Meier method and a Cox proportional hazard model.
  
  
  RESULTS
  We identified 115 women who underwent GT placement, the majority of whom were diagnosed with ovarian cancer (84%). Median time from cancer diagnosis to GT placement was 2.2 years. Median survival following GT placement was 5.6 weeks. A majority (56%) developed GT complications requiring GT revision. While burden of disease as assessed on CT scan by the validated peritoneal cancer index (PCI) was not associated with survival, low CA-125 within one week of GT placement was associated with improved survival (p<0.01). TPN was administered in 36% of women, was associated with concurrent chemotherapy (p<0.001) and a 5 week survival benefit (p<0.01). Chemotherapy after GT was administered in 40% of women and was associated with a 10 week survival benefit (p<0.001). Age-adjusted multivariate analysis identified chemotherapy as the only independent variable associated with survival.
  
  
  CONCLUSIONS
  Women with malignant bowel obstructions from gynecologic cancers requiring palliative GT placement had a guarded prognosis measured in weeks. Gastrostomy tubes near the end of life had a high rate of complications requiring medical intervention. Chemotherapy after GT was associated with TPN administration, and both were associated with a modest extension in survival.
authors: Division of Gynecologic Oncology, Department of OB/GYN, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Yawkey 9, Boston, MA 02114-2696, USA. ediver@partners.org
authors: Elisabeth
authors: E
authors: Diver
authors: Owen
authors: O
authors: O'Connor
authors: Leslie
authors: L
authors: Garrett
authors: David
authors: D
authors: Boruta
authors: Annekathryn
authors: A
authors: Goodman
authors: Marcela
authors: M
authors: Del Carmen
authors: John
authors: J
authors: Schorge
authors: Peter
authors: P
authors: Mueller
authors: Whitfield
authors: W
authors: Growdon
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D005260:Female; D005774:Gastrostomy; D005833:Genital Neoplasms, Female / Q000150:complications* / Q000188:drug therapy / Q000401:mortality; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D016015:Logistic Models; D008875:Middle Aged; D015999:Multivariate Analysis; D010166:Palliative Care / Q000379:methods*; D010289:Parenteral Nutrition, Total; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents