A nationwide study of the use of self-expanding stents in patients with esophageal cancer in Sweden.
OBJECTIVE
Endoscopic insertion of self-expanding metal stents is used for palliative treatment of esophageal and cardia cancer, but the safety profiles, and the influence of age, sex, and hospital volume have not previously been evaluated in a population-based setting.


METHODS
A retrospective population-based study was conducted, including all patients treated with esophageal stenting for malignant disease recorded in Swedish national registries in the period 1997 - 2000. Patients with esophageal or cardia cancer were identified in the cancer registry, and those treated with esophageal stenting were selected from the in-patient registry. Survival and emigration were assessed using the registries for causes of death and emigration, respectively. Procedure-related complications were assessed by reviewing medical records.


RESULTS
Among 1052 registered patients with esophageal or cardia cancer, 402 patients (38 %), with a median age of 74 years, were treated with esophageal stenting. After treatment, the median in-hospital stay was 7 days, and the median survival was 100 days. Survival times were similar between age groups and sexes. Stenting was conducted at 38 Swedish hospitals, with a range of 1-59 procedures at each hospital. Among 152 (38 %) patients who were evaluated for complications, 41 (27 %) had complications of some type, while 20 (13 %) experienced direct procedure-related complications. No differences in complication frequencies were found between high-volume and low-volume centers. There were only two procedure-related deaths (1 %), both due to esophageal perforation. No reduction in the median survival time was found in patients with complications.


CONCLUSIONS
Treatment with self-expanding metal stents is a widely used and reasonably safe procedure among patients with malignant dysphagia, independent of sex, age, or hospital volume in Sweden.
Wenger
U
U
Dept. of Surgery, Karolinska University Hospital, Stockholm, Sweden. urs.wenger@ks.se
Luo
J
J
Lundell
L
L
Lagergren
J
J
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002299:Cardia / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000401:mortality / Q000601:surgery*; D004945:Esophagoscopy / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006276:Health Facility Size; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012737:Sex Factors; D015607:Stents / Q000009:adverse effects*; D013274:Stomach Neoplasms / Q000401:mortality / Q000601:surgery*; D015996:Survival Rate; D013548:Sweden / Q000453:epidemiology