Esophageal stents for the palliation of malignant dysphagia and fistula recurrence after esophagectomy.
BACKGROUND
Despite advances in staging methods, surgical techniques, and adjuvant treatment, recurrent cancer after esophagectomy is a major cause of morbidity and mortality.


OBJECTIVE
Our purpose was to investigate the safety and efficacy of a self-expandable metal stent (SEMS) in patients with dysphagia or fistula caused by recurrent cancer after esophagectomy.


METHODS
Prospective, observational study with standardized treatment and follow-up.


METHODS
Single university center.


METHODS
In 81 patients with recurrent cancer after previous surgical esophagectomy, 100 esophageal SEMSs were inserted for dysphagia (n = 66) or fistula formation (n = 15).


METHODS
Stent placement.


METHODS
Technical and functional outcome, complications, and survival.


RESULTS
The SEMSs restored luminal patency in 65 (98%) of 66 patients and sealed malignant fistulae in 14 (93%) of 15 patients. Stent dysfunction occurred in 24 (30%) of 81 patients. They all were successfully managed by subsequent endoscopic intervention. After stent placement, a total of 16 complications were observed. Major complications occurred in 9 (11%) of 81 patients, mild complications occurred in 7 (9%) of 81 patients. The overall 30-day mortality rate after stent insertion was 25%. Progression of the disease resulted in death after a median interval of 70 days (range 1 day to 91 months).


CONCLUSIONS
Nonrandomized design.


CONCLUSIONS
SEMS placement in recurrent esophageal cancer after surgical resection offers adequate palliation by relieving dysphagia and sealing off esophageal respiratory fistulae. Therefore, in these patients who have a relatively short life expectancy, SEMS placement should be considered the treatment of choice.
Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands.
Nicoline C M
NC
Van Heel
Jelle
J
Haringsma
Manon C W
MC
Spaander
Paul
P
Didden
Marco J
MJ
Bruno
Ernst J
EJ
Kuipers
D003680:Deglutition Disorders / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D004937:Esophageal Fistula / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000150:complications* / Q000601:surgery; D016629:Esophagectomy / Q000009:adverse effects*; D004947:Esophagus / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods*; D011446:Prospective Studies; D012008:Recurrence; D012720:Severity of Illness Index; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome