Undernutrition is predictive of early mortality after palliative self-expanding metal stent insertion in patients with inoperable or recurrent esophageal cancer.
BACKGROUND
Self-expanding metallic stents (SEMS) are a first-line therapeutic procedure in the palliative treatment of dysphagia in patients with esophageal cancer. However, the impact of SEMS insertion on patient nutritional status has never been assessed.


OBJECTIVE
To evaluate the nutritional status of patients after insertion of a SEMS and the impact of a preexisting undernutrition status on survival.


METHODS
Retrospective observational study.


METHODS
A total of 120 patients treated in a single center by insertion of a SEMS for relief of dysphagia in the palliative treatment of esophageal cancer were retrospectively included.


METHODS
Efficacy of SEMS was assessed by the Ogilvie's dysphagia score. Patient nutritional and clinical statuses were evaluated at SEMS insertion, and patients were regularly followed until death. Independent predictive factors of early 30-day mortality were researched.


RESULTS
Dysphagia scores decreased after SEMS insertion in 89.1% of patients, with median scores decreasing from 3.0 to 1.0 (P < .05). There was a significant decrease in body mass index (BMI) (P < .04), serum albumin level (P < .01), and World Health Organization (WHO) performance index (P < .02) at a 1-month evaluation. Serum albumin level, BMI <18 kg/m(2), and WHO performance index >2 at SEMS insertion were independent predictive factors of 30-day mortality.


CONCLUSIONS
This study suggested that palliative stent placement in esophageal cancer was effective to relieve dysphagia but was not followed by an improvement of nutritional parameters. Moreover, it underlined the key role played by undernutrition on survival.
Lecleire
Stéphane
S
Department of Hepato-Gastroenterology and Nutrition, ADEN-EA3234/IFRMP23 Research Group, Rouen University Hospital Charles-Nicolle, France.
Di Fiore
Frédéric
F
Antonietti
Michel
M
Ben Soussan
Emmanuel
E
Hellot
Marie-France
MF
Grigioni
Sébastien
S
Déchelotte
Pierre
P
Lerebours
Eric
E
Michel
Pierre
P
Ducrotté
Philippe
P
D000230:Adenocarcinoma / Q000401:mortality* / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D001835:Body Weight; D002294:Carcinoma, Squamous Cell / Q000401:mortality* / Q000628:therapy*; D002423:Cause of Death; D003680:Deglutition Disorders / Q000401:mortality* / Q000628:therapy*; D004938:Esophageal Neoplasms / Q000401:mortality* / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000401:mortality* / Q000628:therapy*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000628:therapy*; D010166:Palliative Care; D011379:Prognosis; D012189:Retrospective Studies; D012709:Serum Albumin / Q000032:analysis; D016019:Survival Analysis; D016896:Treatment Outcome
D012709:Serum Albumin