Palliative stenting for relief of dysphagia in patients with inoperable esophageal cancer: impact on quality of life.
The aim of palliation in patients with inoperable esophageal cancer is to relieve dysphagia with minimal morbidity and mortality, and thus improve quality of life (QOL). The use of a self-expanding metal stent (SEMS) is a well-established modality for palliation of dysphagia in such patients. We assessed the QOL after palliative stenting in patients with inoperable esophageal cancer. Thirty-three patients with dysphagia due to inoperable esophageal cancer underwent SEMS insertion between October 2004 and December 2006. All patients had grade III/IV dysphagia and locally advanced unresectable cancer (n = 13), distant metastasis (n = 14), or comorbid conditions/poor general health status precluding a major surgical procedure (n = 6). Patients with grade I/II dysphagia and those with carcinoma of the cervical esophagus were excluded. The QOL was assessed using the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 (version 3) and EORTC QLQ-Esophagus (OES) 18 questionnaire (a QOL scale specifically designed for esophageal diseases) before and at 1, 4, and 8 weeks after placement of the stent. The mean age of the patients was 56 (range 34-78) years, and 22 were men. A covered SEMS was used in all patients. The most common site of malignancy was the lower third of the esophagus (n = 18, 55%). In 23 (77%) patients, the stent crossed the gastroesophageal junction. Seven patients required a reintervention for stent block (n = 5) and stent migration (n = 2). Dysphagia improved significantly immediately after stenting, and this improvement persisted until 8 weeks (16.5 vs. 90.6; P < 0.01). The global health status (5.8 vs. 71.7; P < 0.01) and all functional scores improved significantly after stenting from baseline until 8 weeks. Except pain (14.1 vs. 17.7; P = 0.67), there was significant improvement in deglutition (22.7 vs. 2.0; P < 0.01), eating (48 vs. 12.6; P < 0.01), and other symptom scales (19.7 vs. 12.1; P = 0.04) following stenting. The median survival was 4 months (3-7 months). Palliative stenting using SEMS resulted in significant improvement in all scales of QOL without any mortality and acceptable morbidity.
Madhusudhan
Chinthakandhi
C
Department of Gastrointestinal Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
Saluja
Sundeep S
SS
Pal
Sujoy
S
Ahuja
Vineet
V
Saran
Pratap
P
Dash
Nihar R
NR
Sahni
Peush
P
Chattopadhyay
Tushar K
TK
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D015331:Cohort Studies; D003680:Deglutition Disorders / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D004938:Esophageal Neoplasms / Q000150:complications / Q000401:mortality / Q000628:therapy*; D004945:Esophagoscopy / Q000379:methods; D005260:Female; D006801:Humans; D007194:India; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods*; D011336:Probability; D011379:Prognosis; D011446:Prospective Studies; D011788:Quality of Life; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D015607:Stents; D016019:Survival Analysis; D019452:Terminally Ill