Gastrostomies and clinical outcomes: a cohort of different enteral feeding techniques in advanced cancer palliative care
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Abstract
Background: The aim of the study was to assess complications after gastrostomy (GTT) performance using different techniques and the impact on survival of patients with advanced cancer in exclusive palliative care.
Patients and methods: Retrospective study with patients using gastrostomies, hospitalized in the oncology palliative care unit, where complications of the procedure were evaluated according to the period of occurrence and case severity.
Results: A total of 47 patients participated, being 83% male. Surgical gastrostomy was performed in 17%, radiointervention in 51.1% and endoscopy in 31.9%. At the time of GTT indication, functional capacity by Karnofsky Performance Status (KPS) was different between groups and 87.5% patients eligible for surgery had KPS ≥ 60%. On the date scheduled for GTT via surgery, only 50% patients had KPS ≥ 60% and at that time no difference in KPS was observed between the types of intervention. The most frequent complications were abdominal pain and extravasation of the diet. There was no difference in terms of complications regarding the type of technique chosen; however, individuals submitted to radiointervention had a greater 30-day survival. C-reactive protein (CRP) > 10 mg/dL, Modified Glasgow Prognostic Score (mGPS) ≥ 1 and presence of comorbidities were independent predictors of poorer survival.
Conclusions: Our findings are consistent with those reported in the literature regarding complications, regardless of the technique selected. Strategies should be designed to reduce the interval between the indication and the performance of the procedure, in order to preserve the functionality of those patients with a recognized limited survival and to obtain better benefits from this intervention.
Keywords: gastrostomycomplicationspalliative careenteral nutrition
References
- Souza Cunha M, Wiegert EV, Calixto-Lima L, et al. Relationship of nutritional status and inflammation with survival in patients with advanced cancer in palliative care. Nutrition. 2018; (51–52): 98–103.
- Ministério da Saúde. National Consensus Nutrition Oncology — second edition. rev. ampl. atual. Rio de Janeiro: INCA. 2015; 182.
- Silva GA, Wiegert EV, Calixto-Lima L, et al. Clinical utility of the modified Glasgow Prognostic Score to classify cachexia in patients with advanced cancer in palliative care. Clin Nutr. 2020; 39(5): 1587–1592.
- Hui D. Prognostication of survival in patients with advanced cancer: predicting the unpredictable? Cancer Control. 2015; 22(4): 489–497.
- Arends J, Bachmann P, Baracos V, et al. ESPEN guidelines on nutrition in cancer patients. Clin Nutr. 2017; 36(1): 11–48.
- Gonçalves F, Mozes M, Saraiva I, et al. Gastrostomies in palliative care. Support Care Cancer. 2006; 14(11): 1147–1151.
- Loyolla VCL, Pessini L, Bottoni A, et al. Enteral Nutrition therapy in cancer patients under paliative care: a bioethics analysis. Saúde Ética Justiça. 2011; 16(1): 47–59.
- Castro JMF, Frangella VS, Hamada MT. Agreements and disagreements on indication and continuity of enteral nutritional therapy in palliative care patients with non–communicable diseases. ABCS Health Sciences. 2017; 42(1): 55–59.
- Mor V, Laliberte L, Morris J, et al. The Karnofsky performance status scale: An examination of its reliability and validity in a research setting. Cancer. 1984; 53(9): 2002–2007.
- McMillan DC, Crozier JEM, Canna K, et al. Evaluation of an inflammation-based prognostic score (GPS) in patients undergoing resection for colon and rectal cancer. Int J Colorectal Dis. 2007; 22(8): 881–886.
- Dolan RD, McSorley ST, Horgan PG, et al. The role of the systemic inflammatory response in predicting outcomes in patients with advanced inoperable cancer: Systematic review and meta-analysis. Crit Rev Oncol Hematol. 2017; 116: 134–146.
- Tyng CJ, Santos EF, Guerra LF, et al. Computed tomography-guided percutaneous gastrostomy: initial experience at a cancer center. Radiol Bras. 2017; 50(2): 109–114.
- Edelman DS, Unger SW, Russin DR, et al. Laparoscopic gastrostomy. Surg Laparosc Endosc. 1991; 1(4): 251–253.
- Vidhya C, Phoebe D, Dhina C, et al. Percutaneous endoscopic gastrostomy (PEG) versus radiologically inserted gastrostomy (RIG): A comparison of outcomes at an Australian teaching hospital. Clin Nutr ESPEN. 2018; 23: 136–140.
- Rustom IK, Jebreel A, Tayyab M, et al. Percutaneous endoscopic, radiological and surgical gastrostomy tubes: a comparison study in head and neck cancer patients. J Laryngol Otol. 2006; 120(6): 463–466.
- Strijbos D, Keszthelyi D, Gilissen LPL, et al. Percutaneous endoscopic versus radiologic gastrostomy for enteral feeding: a retrospective analysis on outcomes and complications. Endosc Int Open. 2019; 7(11): E1487–E1495.
- Villalba CM, Rodríguez JV, Sánchez FG. Percutaneous endoscopic gastrostomy. Indications, care and complications. Med Clin (Barc). 2019; 152(6): 229–236.
- Cyrany J, Rejchrt S, Kopacova M. Buried bumper syndrome: a complication of percutaneous endoscopic gastrostomy. World J Gastroenterol. 2016; 22(2): 618–627.
- Itkin M, DeLegge MH, Fang JC, et al. Multidisciplinary practical guidelines for gastrointestinal access for enteral nutrition and decompression from the Society of Interventional Radiology and American Gastroenterological Association (AGA) Institute, with endorsement by Canadian Interventional Radiological Association (CIRA) and Cardiovascular and Interventional Radiological Society of Europe (CIRSE). Gastroenterology. 2011; 141(2): 742–765.
- Zuercher BF, Grosjean P, Monnier P. Percutaneous endoscopic gastrostomy in head and neck cancer patients: indications, techniques, complications and results. Eur Arch Otorhinolaryngol. 2011; 268(4): 623–629.
- Yates JW, Chalmer B, McKegney FP. Evaluation of patients with advanced cancer using the Karnofsky performance status. Cancer. 1980; 45(8): 2220–2224.
- Muñoz–Dávila MJ, Ruipera JMX, Guirão GY, et al. Gastrostomy tubes: indications and infectious complications in a tertiary hospital. Rev Esp Quimioter. 2017; 30(5): 334–340.
- Schneider AS, Schettler A, Markowski A, et al. Complication and mortality rate after percutaneous endoscopic gastrostomy are low and indication-dependent. Scand J Gastroenterol. 2014; 49(7): 891–898.
- Ruggeri E, Giannantonio M, Agostini F, et al. Home artificial nutrition in palliative care cancer patients: Impact on survival and performance status. Clin Nutr. 2020; 39(11): 3346–3353.
- Finkelstein EA, Bhadelia A, Goh C, et al. Cross country comparison of expert assessments of the quality of death and dying 2021. J Pain Symptom Manage. 2022; 63(4): e419–e429.
