Temporary Placement of Self-Expanding Oesophageal Stents as Bridging for Neo-Adjuvant Therapy
- 271 Downloads
Placement of self-expanding stents is an effective palliation for dysphagia in non-resectable oesophageal or proximal gastric cancer. The aim of this analysis was to assess the efficacy of temporary stent placement for dysphagia relief during neo-adjuvant treatment for locally advanced disease.
A total of 38 patients scheduled for neo-adjuvant chemo(radio)therapy for locally advanced oesophageal cancer (n = 29), cardia cancer (n = 8) or subcardial gastric cancer (n = 1) underwent placement of self-expanding plastic stents (n = 13) or covered metal stents (n = 25) due to severe dysphagia and weight loss.
Instant dysphagia relief was achieved in 37 (97.4%) of 38 patients. Dysphagia scores declined from mean 3.0 ± 0.7 before stent placement to 0.6 ± 0.9 at restaging. After completion of the neo-adjuvant therapy 20 (52.6%) of the 38 patients underwent resection of the tumour, 5 patients (13.2%) underwent primary resection without receiving chemotherapy while 12 patients (31.6%) did not undergo surgery. Stent-related complications were observed as perforation (n = 1), mediastinitis (n = 1), tracheo-oesophageal fistula (n = 2), bleeding (n = 1) and jejunal perforation caused by a migrated stent (n = 1). Serum albumin significantly decreased in patients with progressive disease despite successful stenting (40.0 ± 4.9 mg/dl versus 29.7 ± 6.4 mg/dl, p < 0.05) while stable albumin levels were found in patients who underwent surgery (39.9 ± 4.3 mg/dl versus 39.1 ± 3.8 mg/dl, p = 0.484).
Placement of self-expanding stents is highly effective for instant dysphagia relief, enabling adequate oral nutrition during neo-adjuvant therapy, but is limited by a high re-intervention rate.
KeywordsStent Placement Stent Migration Prognostic Nutritional Index Stent Removal Proximal Gastric Cancer
- 7.Martin R, Duvall R, Ellis S, Scoggins CR. The use of self-expanding silicone stents in esophageal cancer care: optimal pre-, peri-, and postoperative care. Surg Endosc. 2009;23:615–21.Google Scholar
- 12.Medical Research Council Oesophageal Cancer Working Party. Surgical resection with or without preoperative chemotherapy in oesophageal cancer: a randomised controlled trial. Lancet. 2002;359:1727–33.Google Scholar
- 22.Ott C, Ratiu N, Endlicher E, et al. Self-expanding Polyflex plastic stents in esophageal disease: various indications, complications, and outcomes. Surg Endosc. 2006.Google Scholar
- 24.Verschuur EM, Repici A, Kuipers EJ, Steyerberg EW, Siersema PD. New design esophageal stents for the palliation of dysphagia from esophageal or gastric cardia cancer: a randomized trial. Am J Gastroenterol. 2007.Google Scholar