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


CONCLUSIONS
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.
Sumiyoshi
Tetsuya
T
Department of Endoscopy, National Cancer Center Hospital, Tokyo, Japan.
Gotoda
Takuji
T
Muro
Kei
K
Rembacken
Bjorn
B
Goto
Masahiro
M
Sumiyoshi
Yoko
Y
Ono
Hiroyuki
H
Saito
Daizo
D
D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta / Q000473:pathology; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000401:mortality / Q000628:therapy*; D003680:Deglutition Disorders / Q000628:therapy; D018450:Disease Progression; D004938:Esophageal Neoplasms / Q000150:complications / Q000401:mortality / Q000628:therapy*; D005260:Female; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000628:therapy*; D012189:Retrospective Studies; D015607:Stents; D014138:Tracheoesophageal Fistula / Q000209:etiology / Q000628:therapy