Introduction Percutaneous endoscopic gastrostomy is not widely used in malnourished oesophageal cancer (OC) patients because of concerns about feasibility in frequently obstructive tumours, suitability of the stomach as an oesophageal substitute, and potential for metastatic inoculation. A percutaneaous radiological gastrostomy (PRG) could be an optimal alternative.
Methods Experience with PRG among 1205 consecutive patients presenting with OC from 2000 to 2010 in our department was retrospectively reviewed. PRG was proposed for malnourished patients for whom neoadjuvant chemoradiation was scheduled. PRG placement success rate and major (Dindo-Clavien>II) related complications were analysed. A matched cohort analysis was then constructed in patients who underwent oesophagectomy with gastroplasty (n=759) to evaluate the impact of PRG placement on suitability of the gastric pull-up and on postoperative course. From 76 resected patients with PRG (PRG group), 152 randomly selected controls without PRG (no PRG group) were matched 2:1 by gender, age, ASA grade, cTNM stage and neoadjuvant treatment delivery.
Results PRG placement was planned in 269 (22.3%) patients mainly with locally advanced OC (63.8%). PRG placement was feasible in 259 (96.3%) patients. 60-day PRG-related mortality and major morbidity rates were 0% and 3.8% respectively. For resected patients with gastroplasty, the PRG and no PRG groups were comparable regarding perioperative characteristics except for malnutrition more frequent in the PRG group (p<0.001). At the time of operation, PRG takedown and site closure were uncomplicated and the use of the stomach was possible in all 76 patients. Despite higher malnutrition rate at presentation in the PRG group, overall and oesophageal surgery related morbidity rates were similar between the two groups (p>0.432).
Conclusion PRG is feasible, safe and useful in non-selected patients with OC and does not compromise the suitability of the stomach as an oesophageal substitute in patients deemed to be resectable.
Competing interests None declared.
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