Background: Therapies for inoperable oesophageal cancer include chemoradiotherapy and placement of a self-expanding metal stent (SEMS). Few data are available regarding SEMS as sole therapy for patients with inoperable disease who have not already received, or are unfit for, chemoradiotherapy. The aim of this study was to determine survival, adequacy of palliation, and complications after SEMS placement as sole therapy for inoperable oesophageal cancer in a resource-limited setting.
Methods: Data were prospectively gathered on all patients with oesophageal cancer treated with SEMS between Jan 1, 1999, and May 20, 2008, at a hospital in Kenya where chemoradiotherapy is unavailable. Dysphagia scores, morbidity, mortality, and survival were assessed. Follow-up was done during clinic visits, home visits, and by mobile phone.
Findings: 1000 stents were placed in 951 patients. Long-term follow-up was obtained for 334 patients (35%) with a median survival of 250 days (IQR 130-431, 95%CI 217-301). Mean dysphagia scores improved from 3.3 (SD 0.6) pre-SEMS (n=697) to 1.0 (SD 1.3) for patients (n=78) still alive and 1.8 (SD 1.2) at time of death (n=165). Survival of 17 patients with follow-up who had perforation during tumour dilation (treated with SEMS) was 283 days (IQR 227-538) similar to the 317 patients with follow-up data who did not have a perforation (245 days, 124-430). 20 patients with a tracheo-oesophageal fistula lived a median of 142 days (IQR 73-329). Early complications occurred in 6% (54 of 951 patients) and late complications occurred in 19% (62 of 334 patients). SEMS-related mortality was 0.3% (three of 951).
Interpretation: SEMS effectively palliate inoperable oesophageal cancer. Survival may be longer than previously reported when SEMS are placed in all patients with inoperable oesophageal cancer, as in our study, rather than those failing or unfit for chemoradiotherapy. SEMS seem to be an appropriate technology for palliation of oesophageal cancer in resource-limited settings. Given the proportion of patients lost to follow up, these findings merit further confirmation.