Consequences of preoperative PEG placement

Introduction As part of the preparation for tumor surgery and/or adjuvant treatment, it is common to place a PEG to ensure nutrition.

Methods/results We report on a 67-year-old patient who underwent a transoral and transpharyngeal right partial oropharyngeal resection with defect reconstruction using a radial flap, neck dissection on both sides for a pT2 pN2 cM0 oropharyngeal carcinoma in November 2020. The preoperative PEG placement was without complications. Following the R0 resection, adjuvant RCT with cisplatin was performed and the PEG was removed. At the beginning of 2023, the patient presented again due to upper abdominal pain. A CT abdomen showed an unclear inhomogeneous nodular structure along the large mesh. The access after PEG was hypertrophically scarred. A PEC in the body of the stomach was confirmed in an OGD. A control panendoscopy was performed without evidence of a locoregional recurrence. The visceral surgeon performed a partial gastric resection with abdominal wall resection and cholecystectomy. Histologically, there was evidence of peritoneal carcinomatosis with carcinoma parts in the stomach, abdominal wall and gallbladder in the sense of an implantation metastasis. In the M1 situation, palliative drug-based tumor therapy with cisplatin, 5-FU and pembrolizumab (CPS-score 5) was carried out until August 2023, which was switched to an EXTREME regimen in the event of tumor progression and liver metastases. The patient is currently undergoing maintenance treatment with cetuximab.

Discussion The present case shows the unusual pathomechanism of an implantation metastasis of an oropharyngeal carcinoma. Presumably, tumor cells were transferred from the oropharyngeal side by piercing the gastric wall during PEG placement.

Publication History

Article published online:
13 May 2024