Endoscopy 2019; 51(04): S86
DOI: 10.1055/s-0039-1681421
ESGE Days 2019 oral presentations
Friday, April 5, 2019 17:00 – 18:30: PEG Club B
Georg Thieme Verlag KG Stuttgart · New York

PERCUTANEOUS ENDOSCOPIC GASTROSTOMY IN HEAD AND NECK CANCER PATIENTS: PREDICTORS OF 30-DAY COMPLICATIONS AND MORTALITY

F Taveira
1   Portuguese Oncology Institute of Coimbra, Coimbra, Portugal
,
M Areia
1   Portuguese Oncology Institute of Coimbra, Coimbra, Portugal
,
M João
1   Portuguese Oncology Institute of Coimbra, Coimbra, Portugal
,
L Elvas
1   Portuguese Oncology Institute of Coimbra, Coimbra, Portugal
,
S Alves
1   Portuguese Oncology Institute of Coimbra, Coimbra, Portugal
,
D Brito
1   Portuguese Oncology Institute of Coimbra, Coimbra, Portugal
,
S Saraiva
1   Portuguese Oncology Institute of Coimbra, Coimbra, Portugal
,
AT Cadime
1   Portuguese Oncology Institute of Coimbra, Coimbra, Portugal
› Author Affiliations
Further Information

Publication History

Publication Date:
18 March 2019 (online)

Also available at
 

Aims:

Chemoradiotherapy is essential in the management of head and neck cancer (HNC) patients. Malnutrition during treatment is a major concern and maintaining an enteral feeding route is critical with percutaneous endoscopic gastrostomy (PEG) placement being an option. We intended to elucidate predictors of 30-day complications and mortality during follow-up of HNC patients undergoing PEG.

Methods:

Prospective cohort study of HNC patients with PEG placement, by pull method, in 2017 with a minimum 6-month follow-up. Evaluation of patients' characteristics, comorbidities, nutritional status over time, complications and death. Statistical analysis included descriptive statistics, Qui2 test and multivariable regression.

Results:

Fifty patients, 90% male and mean age of 60 years (± 10). Mean PEG time 7 months (± 0,6). Mainly pharyngeal tumor 48% (n = 24) and advanced TNM stage in 80% (n = 40). ASA≥4 in 22% (n = 11). Initial medium IMC was 20 Kg/m2 (± 3), with 28% of patients presenting an IMC< 18. Registered leukocytosis (40%), anemia (36%) and low albumin (18%) as main analytical abnormalities. Most frequent comorbidity was active smoking (66%). PEG placement before starting oncological treatment in 42%.

Twelve complications (24%) at day 30, mostly respiratory infections (n = 6), with 4 fatalities (8%) but all unrelated to the PEG placement (disease progression).

Most patients managed to maintain weight during follow-up, although with a mean decrease in IMC of 0.42 Kg/m2.

Univariable analysis revealed leukocytosis (p < 0.01), ASA≥4 (p = 0.03) and high CRP (p = 0.05) as major risk factors for 30-day complications. On multivariable analysis leukocytosis as the only risk factor for complications (OR 6, IC95% 2 – 21); Mortality at day 30 only significant related with ASA≥4 (OR 13, IC95% 1,2 – 172).

Conclusions:

PEG placement is relatively safe and feasible in HNC patients with satisfactory results at day 30 and 6 months follow up. Leukocytosis and ASA≥4 are related with worst outcomes. Standardized follow up and multidisciplinary approach are need in this group of patients.