Surgical Feeding Tubes in Pediatric and Adolescent Cancer Patients: A Single-institution Retrospective Review

Abstract

The purpose of our study was to evaluate surgical enteric access in pediatric cancer patients to determine factors associated with postoperative complications. We performed a single institution retrospective review of all patients<21 years old with a primary cancer diagnosis who underwent surgical procedures for enteral access between 2004–2014. Multivariate logistic regression was performed to determine independent predictors of postoperative complications. During the study period, 122 patients had surgically placed feeding tubes, of whom 58% developed one or more complication(s) and 16% experienced a major complication. No single factor was significantly associated with developing any complication or major complication. Several trends were noted including increased complications associated with jejunostomy tubes, percutaneous endoscopic gastrostomy tubes, and abdominal radiation. Surgically placed enteric access in pediatric and adolescent cancer patients is associated with an extremely high complication rate emphasizing the importance of careful evaluation of these patients prior to embarking on surgical feeding access. Future work should evaluate mechanisms to decrease complications and/or explore alternative methods to provide supplemental nutrition in children and adolescents with cancer.

Systematic review of gastrostomy complications and outcomes in pediatric cancer and bone marrow transplant

“…One study was translated from French 36 ; others were in English. All but two studies 17,36 were single-center, with 50% (8 of 16) undertaken in Europe, 17,22,26,[36][37][38][39][40] 44% (7 of 16) in North America, 24,25,27,[41][42][43][44] and one in Australia. 45 Study inclusion periods ranged from 3.5 to 16 years, 25,26 with average ages from 2 to 13 years.…”

“…No studies were randomized, 69% (11 of 16) were case series following one group only (seven were retrospective, 25,27,38,40,[43][44][45] whereas four did not state whether they were retrospective or prospective 26,37,41,42 ), and 31% (5 of 16) were cohort studies 17,22,24,36,39 comparing two groups (only one was prospective 39 ). Comparator groups included children with gastrostomies for noncancer/non-BMT reasons (typically neurological impairment 17,24,39 ) or NGT during cancer treatment without 17 or with BMT.…”

Gastrostomy tube use in children with cancer

“…Reported complication rates associated with GT insertion in children with cancer are high (60%–90%) compared with rates reported in adults with cancer (predominantly head and neck cancer) . Reports of complication rates of GT insertion in children with cancer compared with other children (predominantly with neurological impairment) are conflicting.…”

“…Data specific to children with cancer are limited and must be interpreted with caution. One retrospective study showed a higher rate of postoperative complications in PEG tubes ( n = 28) compared with openly placed GT ( n = 84) in children with cancer . Another retrospective study reported a significantly higher infection rate in GT placed by open surgical technique compared with those placed endoscopically or laparoscopically …”

“…One retrospective study showed a higher rate of postoperative complications in PEG tubes (n = 28) compared with openly placed GT (n = 84) in children with cancer. 39 Another retrospective study reported a significantly higher infection rate in GT placed by open surgical technique compared with those placed endoscopically or laparoscopically. 38 Button GT are not commonly used at initial insertion, and there is limited evidence on their use in children with cancer.…”