Minimally invasive gastrostomy for head and neck cancer patients

Head and neck cancer can be invasive into the upper parts of the gastrointestinal tract which stop passing of food to complete dysphagia. If radically remove of the tumor is impossible, various palliative operations are used to provide patients with enteral nutrition. The purpose of the work is to offer an affordable method of minimally invasive gastrostomy, alternative to puncture techniques.

Material and methods. An analysis of the nutrient fistula formed during puncture gastrostomy was carried out. A literature review has been carried out to search for minimal approaches in volume and trauma and minimally invasive gastrostomy through minilaparotomy has been developed, which allows to provide depleted patients with nutrition at the proper level if it is impossible to apply percutaneous endoscopic methods. These clinical examples prove the advantages of the proposed access and similarity to prototypes of puncture methods. There is no register of patients who have gastrostomy in the Russian Federation, at the request of the St. Petersburg Territorial CMI Fund received data on patients treated in city hospitals and tariffs corresponding to the correction of dysphagia in cancer patients. These data made it possible to assess the prevalence and preferred methods of gastrostomy, as well as the structure of the pathology that causes dysphagia.

Results. Cross-cut puncture methods of gastrostomy is low traumatic surgery in exhausted patients and provide a feeding tube of the required diameter. The pressure method of fistula formation does not cause technical difficulties and can be supplemented by gastropexia. Most patients with dysphagia have a thin anterior abdominal wall, which determines the need for minimal gastrostomy through a minilaparotomy approach, in which the traumatic formation of the nutrient fistula does not exceed the puncture methods of gastrostomy. A clinical example of a patient hospitalized in the surgical department of a multidisciplinary hospital for emergency indications diagnosed with oropharyngeal cancer, a condition after hemiglossectomy with a reconstructive-plastic component, resection of oral bottom tissues, edge resection of the lower jaw with chin flap plasty, fascial-case excision of neck fiber and radiation therapy is given. Tumor progression. Dysphagia 3 Art. Kahexia. Tracheophageal fistula? Histological conclusion: squamous cell keratinizing cancer G1. This patient was successfully performed an operation according to the proposed method with gastrostomy tube 20 Fr. On the 10th day after the operation, the stitches were removed, the patient received adequate nutrition through gastrostomy, discharged in satisfactory condition for outpatient treatment. No postoperative complications were identified, the gastrostoma functioned, a balanced diet was provided. The patient received symptomatic therapy at the place of residence, was observed for two months. Conclusion. Minimal gastrostomy through minilaparotomy in its invasiveness approaches puncture percutaneous gastrostomy, is characterized by simple technique and high availability. This method can be offered to patients with a thin anterior abdominal wall if other minimally invasive methods are not available. Key words: gastrostomy, head and neck tumors, dysphagia, minilaparotomy, nutritious fistula, probe nutrition, Territorial Fund, compulsory health insurance, puncture gastrostomy, percutaneous gastrostomy, puncture method, palliative care

Conflicts of interest. The authors have no conflicts of interest to declare.
Funding. There was no funding for this study
For citation: Gavshchuk M.V., Gostimskii A.V., Romanchishen A.F., Vabalayte K.V., Lisovskii O.V., Lisitsa I.A. Minimally invasive gastrostomy for head and neck cancer patients. Head and neck. Russian Journal. 2024;12(1):9–15