title: Percutaneous endoscopic gastrostomy site metastasis from head and neck squamous cell carcinoma: case series and literature review.
abstract: OBJECTIVE
  To present our experience with head and neck squamous cell carcinoma (HNSCC) seeding of percutaneous endoscopic gastrostomy (PEG) sites and to review all reported cases to identify risk factors and develop strategies for complication avoidance.
  
  
  METHODS
  The records of 4 patients with PEG site metastasis from HNSCC were identified from the authors' institution. Thirty-eight further cases were reviewed following a PubMed search and evaluation of references in pertinent articles.
  
  
  RESULTS
  Review of 42 cases revealed the average time from PEG to diagnosis of metastatic disease to be 8 months. Average time to death from detection of PEG disease was 5.9 months. One-year survival following PEG metastasis was 35.5% with an overall mortality of 87.1%.
  
  
  CONCLUSIONS
  PEG site metastatic disease portends a poor prognosis. Early detection and aggressive therapy may provide a chance of cure. Changes in PEG technique or in timing of adjunctive therapies are possible avenues in further research to prevent this complication.
authors.affiliation: Department of Otolaryngology - Head and Neck Surgery, Virginia Commonwealth University Massey Cancer Center, Richmond, VA, USA. athuang@mdanderson.org.
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Huang
authors.forename: Alexandros
authors.initials: A
authors.lastname: Georgolios
authors.forename: Sasa
authors.initials: S
authors.lastname: Espino
authors.forename: Brian
authors.initials: B
authors.lastname: Kaplan
authors.forename: James
authors.initials: J
authors.lastname: Neifeld
authors.forename: Evan R
authors.initials: ER
authors.lastname: Reiter
mesh_terms: D034861:Abdominal Wall / Q000473:pathology* / Q000601:surgery; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000556:secondary*; D003131:Combined Modality Therapy; D017809:Fatal Outcome; D005774:Gastrostomy / Q000009:adverse effects*; D006258:Head and Neck Neoplasms / Q000473:pathology*; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000473:pathology; D007822:Laryngeal Neoplasms / Q000473:pathology / Q000532:radiotherapy; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection; D009364:Neoplasm Recurrence, Local; D009366:Neoplasm Seeding; D011379:Prognosis; D056144:Pyriform Sinus; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D012307:Risk Factors; D000077195:Squamous Cell Carcinoma of Head and Neck; D013274:Stomach Neoplasms / Q000556:secondary; D014062:Tongue Neoplasms / Q000473:pathology / Q000532:radiotherapy