Prophylactic Versus Reactive Gastrostomy Tube Placement for Advanced Head and Neck Cancer Patients
Introduction: The use of gastrostomy tubes (GT) has become common among advanced head and neck cancer patients. This chapter aims to review the available evidence comparing the utility of prophylactic gastrostomy tubes (pGT) placement versus the reactive gastrostomy tubes placement (rGT).
Methodology: Based on the PICO format, PubMed and Google Scholar databases were screened for eligibility according to predetermined inclusion and exclusion criteria. Only articles having two arms comparing prophylactic to reactive gastrostomy tube placement were included. Review articles and consensus statements were excluded.
Results: There are few double-armed studies in the literature examining the difference in outcomes between pGT and rGT. The results from across the studies are variable and heterogeneous making cross comparison of the data challenging. Overall, neither pGT nor rGT seemed to offer any clear advantages regarding nutritional outcomes, length of dependency, severity of dysphagia, or survival.
Conclusion: Optimally timing the GT placement in advanced head and neck cancer patients is a challenging decision. The decision should be individualized to each patient based on the desired outcomes. While pGT does not seem to offer any clear advantages over rGT, the rGT approach might be a preferable approach when the healthcare facility is equipped for a prompt GT placement when or if the need arises.
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