Metastatic spread to a percutaneous gastrostomy site from head and neck cancer: case report and literature review.

BACKGROUND

The placement of percutaneous endoscopic gastrostomy tubes is a common procedure in patients with head and neck cancer who require adequate nutrition because of the inability to swallow before or after surgery and adjuvant therapies. A potential complication of percutaneous endoscopic gastrostomy tubes is the metastatic spread from the original head and neck tumor to the gastrostomy site.

METHODS

This is a case of a 59-year-old male with a (T4N2M0) Stage IV squamous cell carcinoma of the oropharynx who underwent percutaneous endoscopic gastrostomy tube placement at the time of his surgery and shortly thereafter developed metastatic spread to the gastrostomy site. A review of the published literature regarding the subject will be made.

RESULTS

Twenty-nine cases of percutaneous endoscopic gastrostomy site metastasis occurring in patients with head and neck cancer have been previously reported in the literature. The pull-through method of gastrostomy tube placement had been used in our patient as well as in the majority of the other cases reviewed in the literature.

CONCLUSION

The metastatic spread of head and neck cancer to the percutaneous endoscopic gastrostomy site is a very rare occurrence. The direct implantation of tumor through instrumentation is the most likely explanation for metastasis; however, hematogenous seeding is also a possibility. To prevent this rare complication, other techniques of tube insertion need to be considered.