Morbidity and mortality after self-expandable metallic stent placement in patients with progressive or recurrent esophageal cancer after chemoradiotherapy

Gastrointest Endosc. 2003 Jun;57(7):882-5. doi: 10.1016/s0016-5107(03)70024-8.

Abstract

Background: Placemet of self-expandable metallic stents in patients with advance esophageal cancer improves dysphagia and occludes tracheoesophageal fistulas. However, the safety of self-expandable metallic stents for patients who have undergone chemoradiotherapy is controversial. This study evaluated the morbidity and modality after self-expandable metallic stent placement in patients with progressive or recurrent esophageal cancer after chemoradiotherapy.

Methods: A total of 22 patients in whom self-expandable metallic stents were placed because of progressive or recurrent esophageal cancer after chemoradiotherapy were studied.

Results: All 22 patients had dysphagia, and 13 had a tracheoesophageal fistula. After self-expandable metallic stent placement, the mean dysphagia grade improved from 3.5 to 0.9, and tracheoesophageal fistula was successfully managed in all cases. Seventeen patients had T4 stage disease, and among 8 of them with invasion to the aorta, 6 (75%) died of sudden massive hemorrhage. Median survival for these 6 patients was 31 days (range 13-63 days) compared with 67 days (range 4-262 days) for all patients after self-expandable metallic stent placement.

Conclusion: Self-expandable metallic stent placement improved dysphagia and was useful for treatment of tracheoesophageal fistula. However, for patients with T4 lesions that invade to the aorta, self-expandable metallic stent placement after chemoradiotherapy should be considered carefully.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Aorta / pathology
  • Carcinoma, Squamous Cell / complications
  • Carcinoma, Squamous Cell / mortality
  • Carcinoma, Squamous Cell / therapy*
  • Deglutition Disorders / therapy
  • Disease Progression
  • Esophageal Neoplasms / complications
  • Esophageal Neoplasms / mortality
  • Esophageal Neoplasms / therapy*
  • Female
  • Hemorrhage / etiology
  • Humans
  • Male
  • Middle Aged
  • Neoplasm Invasiveness
  • Neoplasm Recurrence, Local / therapy*
  • Retrospective Studies
  • Stents*
  • Tracheoesophageal Fistula / etiology
  • Tracheoesophageal Fistula / therapy