In-hospital and long-term outcomes in patients with malignancy undergoing percutaneous endoscopic gastrostomy (PEG)
| Autor: | Guilherme Rabinowits, Emily Z. Keung, Xiaoxia Liu, Vihas Patel, Afrin Nuzhad |
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| Rok vydání: | 2012 |
| Předmět: | |
| Zdroj: | Journal of Clinical Oncology. 30:9086-9086 |
| ISSN: | 1527-7755 0732-183X |
| DOI: | 10.1200/jco.2012.30.15_suppl.9086 |
| Popis: | 9086 Background: PEG is widely performed in cancer patients as a means of providing nutrition or palliation. Although considered safe, PEG-associated outcomes in these patients remain poorly described. We examined the safety and benefits of PEG placement in this patient population. Methods: A five year retrospective review of all patients with malignancy (excluding head/neck, thoracic) who underwent attempted PEG at our institution was performed. Results: PEG was placed in 187 of 189 patients; 64 with hematologic malignancy (H-M), 125 non-hematologic malignancy (NH-M). Median age at time of PEG was 60.8 years. Indication was nutritional support (100%) in H-M, enteral access (59.2%) and management of obstructive symptoms (38.4%) in NH-M. A minority were able to return home (27.5%), discontinue parenteral nutrition (22%), advance diet for nutrition (24.6%) or comfort (17.1%) with the rest remaining NPO. Overall rates of PEG-related major (aspiration, tube dislodgement/leakage, bleeding, visceral injury, respiratory failure after procedure, cardiac arrest) and minor (superficial infection, ileus) complications were 21.4% and 11.3%, respectively, with higher rates in H-M (34.4% and 20.3% vs 14.4% and 6.4%). All cause in-hospital mortality was high: 31.3% H-M, 13.6% NH-M. Median time from PEG placement to death was 54 days. Leading cause of death differed by malignancy: respiratory failure and sepsis in H-M (31% and 21%), primary malignancy in NH-M (75%). Overall one year mortality was 56%. Code status was changed in 21% of patients after PEG (“Full Code” to “Do Not Resuscitate/Do No Intubate” or “Comfort Measures Only”). Multivariate/subgroup analyses will be presented at time of meeting. Conclusions: PEG placement in this study population was associated with significant procedure-related complications and failed to achieve TPN independence or advancement of diet. Nearly 25% of patients declined aggressive resuscitation strategies after undergoing surgery for PEG. Thus, higher burden of counseling is needed to carefully weigh the risk and benefit of PEG placement in these patients. Further studies are needed to elucidate the factors affecting the decision process and patient selection. |
| Databáze: | OpenAIRE |
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