Table 1_Timing matters: gastrostomy placement and outcomes in patients with head and neck cancer undergoing chemoradiotherapy.docx

Compared with very-late placement, survival did not differ at 1–2 years (HR 0.90, 95% CI 0.65–1.25) but was higher at 2–5 years (88.4% vs. 83.2%; HR 0.69, 95% CI 0.48–0.98); adjusted HRs were 0.72 (0.54–0.96) and 0.61 (0.45–0.83), respectively. Survival was higher with prophylactic versus late-reactive placement at 1–2 years (84.2% vs. 77.8%; HR 0.70, 95% CI 0.54–0.90), but not at 2–5 years (HR 0.64, 95% CI 0.32–1.26).

Prophylactic placement was associated with fewer gastrostomy-related complications than very-late placement (1.8% vs. 3.1% at 1–2 years; 1.3% vs. 2.6% at 2–5 years), less aspiration pneumonia at 1–2 years (1.0% vs. 1.9%), and higher serum albumin (3.89 vs. 3.70 g/dL; all p < 0.05), while malnutrition (p = 0.10) and body mass index (p = 0.45) did not differ.</p>Conclusion<p>Prophylactic and early-reactive placement had comparable post-gastrostomy survival, supporting early-reactive placement as a reasonable alternative in appropriately monitored patients.

Poorer outcomes with late and very-late placement may identify a clinically higher-risk population rather than demonstrate a benefit of earlier placement. Prospective target-trial emulation studies are needed to define optimal timing.</p>