International Journal of Head and Neck Surgery

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VOLUME 2 , ISSUE 1 ( January-April, 2011 ) > List of Articles


Metastatic Implantation of Head and Neck Squamous Cell Cancer at PEG Tube Site Exit— An Unusual Relapse Site: A Case Report and Review of Literature

Vijay Palwe, Kaustav Talpatra, Umesh Mahantshetty, Seethalaxmi Viswanathan

Citation Information : Palwe V, Talpatra K, Mahantshetty U, Viswanathan S. Metastatic Implantation of Head and Neck Squamous Cell Cancer at PEG Tube Site Exit— An Unusual Relapse Site: A Case Report and Review of Literature. Int J Head Neck Surg 2011; 2 (1):53-56.

DOI: 10.5005/jp-journals-10001-1048

Published Online: 01-08-2012

Copyright Statement:  Copyright © 2011; The Author(s).



The placement of percutaneous endoscopic gastrostomy (PEG) 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.


This is a case of a 55-year-old male with a (cT4N3M0) stage IV squamous cell carcinoma of the oropharynx who underwent percutaneous endoscopic gastrostomy tube placement prior to commencement of definitive chemoradiation therapy and 7 months thereafter developed metastatic spread to the gastrostomy site. Tumor was treated with radiation therapy. A review of the published literature regarding the subject is done. 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.


There is a small but definite risk for tumor implantation in the gastrostomy site when using the pull technique in patients with active head and neck cancer. The direct implantation of tumor through instrumentation is the most likely explanation for metastasis; however, hematogenous seeding is also a possibility. Careful assessment of the oropharynx and hypopharynx before PEG tube placement and the use of alternative techniques for enteral access in patients with untreated or residual malignancy are recommended to minimize this risk.

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  1. Gastrostomy without laparotomy: A percutaneous endoscopic technique. J Paediatr Surg 1980;15:872-75.
  2. Percutaneous gastrostomy: A new simplified and cost-effective technique. Am J Surg 1984;148:132-37.
  3. Percutaneous endoscopic gastrostomy in patients with head and neck cancer. Endoscopy 1988;18: 149-52.
  4. Percutaneous endoscopic gastrostomy. Am J Gastroenterol 1989;84:703-09.
  5. Percutaneous endoscopic gastrostomy. Gastrointest Endosc Clin N Am 1998;8:551-68.
  6. Wound implantation: A surgical hazard. Br J Surg 1977;64:872-75.
  7. Metastatic implantation of an oral squamous cell carcinoma at a percutaneous endoscopic gastrostomy site. Surg Endosc 1994;8:1232-35.
  8. Tumour seeding following percutaneous endoscopic gastrostomy placement in head and neck cancer. Postgrad Med J 1997;73:430-32.
  9. Stomal seeding of head and neck cancer by percutaneous endoscopic gastrostomy tube placement. Ann Surg Oncol 1995;2:170-73.
  10. Metastatic head and neck cancer to the percutaneous endoscopic gastrostomy exit site: A case report and review of the literature. Am Surg 1997;63:481-86.
  11. Metastasis to a percutaneous gastrostomy site from head and neck cancer: Radiobiologic considerations. Head Neck 2000;22:826-30.
  12. Metastatic head and neck carcinoma to a percutaneous endoscopic gastrostomy site 14 February 2005 in Wiley Inter Science.
  13. Port-site tumour recurrence of oral squamous carcinoma following percutaneous endoscopic gastrostomy: A lesson to be aware of. World Journal of Surgical Oncology 2006.
  14. Gastric metastasis of squamous cell carcinoma of the head and neck after percutaneous endoscopic gastrostomy: Report of a case. Endoscopy 1989;21:295.
  15. Complications of laparoscopy. Endoscopy 1992;24: 693-700.
  16. Molecular biology of cancer: Invasion and metastasis. In: DeVita V (Jr), Hellman S, Rosenberg S (Eds). Cancer: Principles and practice of oncology. Philadelphia: Lippincott-Raven (8th ed), 2008;119-36.
  17. The influence of surgical trauma on experimental metastasis. Cancer 1989;64:2035-44.
  18. Growth rate and cell kinetics in human tumours: Some prognostic and therapeutic implications. In: Symington T, Carter R (Eds). Scientific foundations of oncology. Chicago: Year Book 1976;126-36.
  19. Biology of tumor growth. Hosp Pract 1983;18: 81-90.
  20. The significance of hematogenous tumor cell clumps in the metastatic process. Cancer Res 1976;36:889.
  21. Incidence of abdominal wall metastasis complicating PEG tube placement in untreated head and neck cancer. RN Gastrointest Endosc 2005;62:708-11.
  22. Implantation metastasis after PEG: Case report and review. Gastrointest Endosc 2000;51:480-84.
  23. Percutaneous endoscopic gastrostomy (PEG): Indications and technique. Operative Techniques Otolaryngol– Head Neck Surg 1997;8:77-84.
  24. Percutaneous endoscopic gastrostomy: Avoiding complications. Otolaryngol Head Neck Surg 1999;120:195-99.
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