Percutaneous radiological gastrostomy in esophageal cancer patients: a feasible and safe access for nutritional support
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Percutaneous radiological gastrostomy in esophageal cancer patients: a feasible and safe access for nutritional support during multimodal therapy Williams Tessier • Guillaume Piessen • Nicolas Briez • Arianna Boschetto • Ge´raldine Sergent Christophe Mariette
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Received: 7 March 2012 / Accepted: 5 July 2012 / Published online: 7 September 2012 Ó Springer Science+Business Media, LLC 2012
Abstract Background Percutaneous endoscopic gastrostomy is not widely used in malnourished esophageal cancer (EC) patients because of concerns about its feasibility in frequently obstructive tumors, suitability of the stomach as an esophageal substitute, and potential for metastatic inoculation. A percutaneous radiological gastrostomy (PRG) could be an optimal alternative. Methods Experience with PRG among 1,205 consecutive patients presenting with EC from 2002 to 2011 in our department was retrospectively reviewed. PRG was mostly utilized for malnourished patients for whom neoadjuvant chemoradiation was scheduled. The rates of both successful placement and major related complications (DindoClavien CIII) were analyzed. A matched cohort analysis was constructed in patients who underwent esophagectomy with gastroplasty (n = 688) to evaluate the impact of PRG placement on the suitability of the gastric conduit and on postoperative course. For 78 resected patients with PRG W. Tessier G. Piessen (&) N. Briez A. Boschetto C. Mariette Department of Digestive and Oncological Surgery, University Hospital Claude Huriez, Centre Hospitalier Re´gional Universitaire, Place de Verdun, 59037 Lille, France e-mail: [email protected] W. Tessier G. Piessen N. Briez G. Sergent C. Mariette University of Lille Nord de France, Lille, France W. Tessier G. Piessen C. Mariette Inserm UMR 837, Jean Pierre Aubert Research Center, Team 5 ‘‘Mucins, Epithelial Differentiation and Carcinogenesis’’, Lille, France G. Sergent Department of Radiology, University Hospital Claude Huriez, Centre Hospitalier Re´gional Universitaire, Lille, France
(PRG group), 156 randomly selected controls without PRG (no PRG group) were matched 2:1 for gender, age, ASA grade, clinical TNM stage, and neoadjuvant treatment delivery. Results PRG placement was planned in 269 (22.3 %) patients mainly with locally advanced EC (63.8 %). PRG placement was feasible in 259 (96.3 %) patients. Sixty-day PRG-related mortality and major morbidity rates were 0 and 3.8 % respectively. For resected patients, the PRG and no PRG groups were comparable regarding perioperative characteristics, except for malnutrition, which was 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 78 patients. Despite a higher malnutrition rate at presentation in the PRG group, rates of overall morbidity, and morbidity related to esophageal surgery, were similar between the two groups (P [ 0.258). Conclusion PRG is feasible, safe, and useful in
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