The Impact of Tumor Seeding from Preoperative Percutaneous Endoscopic Gastrostomy Tubes on Recurrence and Survival After Esophagectomy for Locally Advanced Esophageal Carcinoma

Background: Patients with malignant dysphagia and protein-calorie malnutrition from locally advanced esophageal cancer often require enteric nutritional support. Percutaneous endoscopic gastrostomy (PEG) tubes are commonly used in cancer patients. However, the impact of tumor seeding along the gastrostomy tract and its influence on recurrence and survival has not been described. Methods: We performed a retrospective study of patients who underwent esophagectomy for locally advanced esophageal carcinoma by a single surgeon from December 1, 2014 through July 31, 2024. We ascertained risk ratios and 95% confidence intervals to examine the association between implant seeding and recurrence. Kaplan-Meier curves were used to assess survival. Results: Of the 172 patients who underwent esophagectomy over the study period, 14 had PEG tubes placed prior to referral for esophagectomy. Of these, 4 (29%) had tumor seeding at the PEG site. Those who had tumor seeding were 2.5 times (95% CI: 0.83-7.53) ( P = 0.25) more likely to recur and had a lower median survival (22.8 months; range, 13.2-30.7), as compared with those who did not (median, 33.6 months; range, 7.1-69.7) ( P = 0.11), although neither result reached statistical significance. Conclusions: We noted that pre-treatment PEG tubes in patients with locally advanced esophageal carcinoma are associated with a high risk of tumor seeding, which has a negative impact on recurrence and survival rates. For those patients being treated for cure and in need of enteric nutritional support, we recommend alternative feeding access, such as a jejunostomy.