Metastasis to the gastrostomy site in patients with upper aerodigestive tract (UADT) malignancies is a rare but devastating adverse event that has been poorly described. Our aim was to determine the overall incidence and clinicopathological characteristics observed with development of gastrostomy site metastasis in patients with UADT cancers.Systematic review and meta-analysis of 6,138 studies retrieved from MEDLINE, EMBASE, CINAHL, and the Cochrane Register after being queried for studies including gastrostomy site metastasis in patients with UADT malignancies.The final analysis included 121 studies. Pooled analysis showed overall event rate gastrostomy site metastasis to be 0.5% (95% CI, 0.4%-0.7%). Subgroup analysis showed an event rate of 0.56% (95% CI, 0.40%-0.79%) with the pull technique and 0.29% (95% CI, 0.15%-0.55%) with the push technique. Clinicopathological characteristics observed with gastrostomy site metastasis included: late stage disease (T3/T4) (57.8%), positive lymph node status (51.2%), and no evidence of systemic disease (M0) (62.8%) at initial presentation. Average time from gastrostomy placement to diagnosis of metastasis was 7.78 ± 4.9 months, average tumor size on detection was 4.65 (SD, 2.02) cm, and average length of survival was 7.26 (SD, 6.23) months.Gastrostomy site metastasis is a rare, but serious adverse event that occurs at an overall rate of 0.5%, particularly in patients with advanced stage disease, and is observed with a very poor prognosis. These findings emphasize a need for clinical practice guidelines to include a regular assessment of the PEG site and highlight the importance of detection and management of gastrostomy site metastasis by the multidisciplinary care oncology team.