Percutaneous endoscopic gastrostomy at the time of tumour resection in advanced oral cancer

The role of percutaneous endoscopic gastrostomy (PEG) in patients undergoin g resection of head and neck malignancy is well established. The procedure may be performed pre- or post-operatively with intravenous sedation or alte rnatively under general anaesthesia at the time of tumour resection. There are concerns as to the safety of PEG, particularly when performed under int ravenous sedation. Elderly patients with poor general health and those with airway compromise may be at significant risk. We believe that patients wit h advanced oral malignancy often fall into such groups and, therefore, we r outinely perform PEG at the time of resection. The aim of this study was to determine the potential risk Factors for PEG insertion in patients with ad vanced oral malignancy and present our experience with insertion at the tim e of rt section. A retrospective study was undertaken of the risk factors f or PEG insertion in 72 consecutive patients with stage IV oral cancer treat ed between April 1993 and March 2000. Age, sex, tumour site, past medical h istory, American Society of Anaesthesiologists (ASA) and laryngoscopy grade , as an assessment of potential airway compromise, were recorded. There wer e 72 patients, 40 males and 32 females, with a mean age of 63 years (27-90) . Eighteen patients (25%) scored 3 or 4 on the ASA scores of physical statu s. Laryngoscopy grades were recorded in 65 patients, of these, 18 (25%) had reduced visualisation of the larynx and in two patients not even the epigl ottis could be seen. It is concluded that patients with advanced oral cance r have significant risk factors for PEG placement. However. PEG can he safe ly performed at the time of ablative surgery and has the advantage of avoid ing an additional operative event for the patient. (C) 2000 Elsevier Scienc e Ltd. All rights reserved.