title: Morbidity and mortality after self-expandable metallic stent placement in patients with progressive or recurrent esophageal cancer after chemoradiotherapy.
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.
  
  
  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.
authors.affiliation: Department of Endoscopy, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Sumiyoshi
authors.forename: Takuji
authors.initials: T
authors.lastname: Gotoda
authors.forename: Kei
authors.initials: K
authors.lastname: Muro
authors.forename: Bjorn
authors.initials: B
authors.lastname: Rembacken
authors.forename: Masahiro
authors.initials: M
authors.lastname: Goto
authors.forename: Yoko
authors.initials: Y
authors.lastname: Sumiyoshi
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Ono
authors.forename: Daizo
authors.initials: D
authors.lastname: Saito
mesh_terms: 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