title: Incidence of abdominal wall metastases following percutaneous endoscopic gastrostomy placement in patients with head and neck cancer.
abstract: Percutaneous endoscopic gastrostomy (PEG) tubes are an effective modality for enteral nutrition in patients with head and neck cancer; however, there have been documented case reports of "seeding" of the abdominal wall by the theoretic risk of dragging the tube along the tumor during PEG placement. The objective of this study is to determine the incidence and contributing risk factors leading to metastasis to the abdominal wall following PEG placement in patients with head and neck cancer.
  
  
  
  A retrospective chart review was performed on patients diagnosed with head and neck malignancy who underwent PEG placement between 1/5/2009 and 12/22/2014. Variables collected included development of abdominal wall metastases, type of malignancy and tumor characteristics, smoking history, PEG placement technique, and survival following recurrence. Data were then analyzed for overall trends.
  
  
  
  Out of 777 patients analyzed, a total of five patients with head and neck malignancy were identified with abdominal wall metastasis following PEG tube placement with an overall incidence of 0.64% over an average follow-up of 27.55 months. All of these patients underwent PEG tube insertion via a Pull technique. One patient was found to have a clinically evident and symptomatic stomal metastasis, while the other four patients had radiologically detected metastases either on CT or PET scan. All of the identified patients were found to have stage IV oral cancer at time of initial diagnosis of their head and neck malignancy, followed by widespread distant metastatic disease at time of presentation with their PEG site stomal metastasis.
  
  
  
  Abdominal wall metastases following PEG placement are a rare but serious complication in patients with head and neck malignancy.
authors.affiliation: Division of General and Gastrointestinal Surgery, The Ohio State University Wexner Medical Center, 395 W. 12th Avenue, Suite 654, Columbus, OH, 43210, USA.
authors.forename: Eleanor
authors.initials: E
authors.lastname: Fung
authors.affiliation: Division of General and Gastrointestinal Surgery, The Ohio State University Wexner Medical Center, 395 W. 12th Avenue, Suite 654, Columbus, OH, 43210, USA. david.strosberg@osumc.edu.
authors.forename: David S
authors.initials: DS
authors.lastname: Strosberg
authors.affiliation: Department of Surgery, University of Colorado at Denver, Aurora, CO, USA.
authors.forename: Edward L
authors.initials: EL
authors.lastname: Jones
authors.affiliation: Division of General and Gastrointestinal Surgery, The Ohio State University Wexner Medical Center, 395 W. 12th Avenue, Suite 654, Columbus, OH, 43210, USA.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Dettorre
authors.affiliation: Division of General and Gastrointestinal Surgery, The Ohio State University Wexner Medical Center, 395 W. 12th Avenue, Suite 654, Columbus, OH, 43210, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Suzo
authors.affiliation: Division of General and Gastrointestinal Surgery, The Ohio State University Wexner Medical Center, 395 W. 12th Avenue, Suite 654, Columbus, OH, 43210, USA.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Meara
authors.affiliation: Division of General and Gastrointestinal Surgery, The Ohio State University Wexner Medical Center, 395 W. 12th Avenue, Suite 654, Columbus, OH, 43210, USA.
authors.forename: Vimal K
authors.initials: VK
authors.lastname: Narula
authors.affiliation: Division of General and Gastrointestinal Surgery, The Ohio State University Wexner Medical Center, 395 W. 12th Avenue, Suite 654, Columbus, OH, 43210, USA.
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Hazey
mesh_terms: D000008:Abdominal Neoplasms / Q000453:epidemiology / Q000209:etiology / Q000556:secondary*; D034861:Abdominal Wall / Q000473:pathology* / Q000601:surgery; D000328:Adult; D000368:Aged; D002277:Carcinoma / Q000453:epidemiology / Q000209:etiology / Q000556:secondary*; D004724:Endoscopy; D004750:Enteral Nutrition / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D005774:Gastrostomy / Q000009:adverse effects* / Q000379:methods; D006258:Head and Neck Neoplasms / Q000473:pathology*; D006801:Humans; D015994:Incidence; D007441:Intubation, Gastrointestinal / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D009366:Neoplasm Seeding; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Abdominal wall metastasis; Head and neck cancer; PEG; Stoma metastasis