title: Inoperable adenocarcinoma of the oesophagogastric junction: a comparative clinical study of laser coagulation versus self-expanding metallic stents with special reference to cost analysis.
abstract: OBJECTIVE
  Neither clinical nor financial comparisons yet exist between self-expanding metallic stents (SEMS) and laser therapy, concentrating on the treatment of obstructive adenocarcinomas of the oesophagogastric junction. The aim of our study was to compare the relative lifetime costs and clinical results of the Nd:YAG laser to those of SEMS as alternative forms of primary palliation of dysphagia for adenocarcinoma near the oesophagogastric junction.
  
  
  METHODS
  Fifty-two patients with distal oesophageal or oesophagogastric adenocarcinomas underwent palliative treatment for dysphagia: 32 treated with laser therapy and 20 with SEMS in this retrospective study. The clinical outcome and real cumulative costs as physical units and in financial terms were analysed for these study groups.
  
  
  RESULTS
  Although patients palliated with SEMS underwent fewer procedures (1.9+/-1.6 vs 3.4+/-4.0, P=0.0048) and spent less time in endoscopic theatre (38+/-25min vs 118+/-152min, P=0.0048), they spent as many days in hospital (12.9 vs 15.1, P=0.370) and required as high overall costs for therapy (5360 EUR vs 5450 EUR, P=0.679) as those treated with laser therapy. In addition, they had higher morbidity rates (30 vs 6.3%, P=0.043), hospital mortality (20 vs 3.1%, P=0.066), and 30-day mortality (40 vs 3.1%, P=0.0011) than did patients with laser therapy, with no evidence of SEMS being the more effective treatment modality.
  
  
  CONCLUSIONS
  In patients with adenocarcinoma at the distal oesophagus or at the oesophagogastric junction, laser therapy palliates dysphagia effectively with lower morbidity and mortality rates and without increased costs or hospital stays than does use of self-expanding metallic stents.
authors.affiliation: Department of Cardiothoracic Surgery, Helsinki University Hospital, Helsinki, Finland.
authors.forename: E I T
authors.initials: EI
authors.lastname: Sihvo
authors.forename: T
authors.initials: T
authors.lastname: Pentikäinen
authors.forename: M E
authors.initials: ME
authors.lastname: Luostarinen
authors.forename: O J
authors.initials: OJ
authors.lastname: Rämö
authors.forename: J A
authors.initials: JA
authors.lastname: Salo
mesh_terms: D000230:Adenocarcinoma / Q000150:complications / Q000473:pathology / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D003365:Costs and Cost Analysis; D003680:Deglutition Disorders / Q000209:etiology / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery*; D004943:Esophagogastric Junction; D004945:Esophagoscopy / Q000191:economics; D005260:Female; D006801:Humans; D017075:Laser Coagulation / Q000191:economics; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010166:Palliative Care / Q000191:economics; D012189:Retrospective Studies; D015607:Stents / Q000191:economics; D016896:Treatment Outcome