title: Stents for proximal esophageal cancer: a case-control study.
abstract: BACKGROUND
  Self-expandable metal stents (SEMSs) are an established palliative therapy for esophageal cancer. SEMS placement for cancers near the upper esophageal sphincter (UES) is controversial because of a perceived increased risk of complications.
  
  
  OBJECTIVE
  To compare outcomes after patients stented for proximal esophageal cancer (PC) and distal esophageal cancer (DC).
  
  
  METHODS
  Matched case-control study from a prospective database.
  
  
  METHODS
  Tertiary referral center, Tenwek Hospital, Bomet, Kenya.
  
  
  METHODS
  All patients with PC located within 6 cm of the UES were matched with randomly selected controls with DC.
  
  
  METHODS
  Outcomes of PC cases were compared with those of DC controls.
  
  
  METHODS
  Dysphagia score, complications, median survival.
  
  
  RESULTS
  A total of 151 patients with PC were identified and were randomly matched with DC controls. Ninety-three case-control pairs had adequate follow-up information available. Mean dysphagia scores (scale 0-4) improved from 3.4 and 3.3 before stenting for PC and DC, respectively, to 1.5 after stenting for both groups (P = .93). Early complications occurred in 6.5% of PC cases and 9.7% of DC controls (P = .44). Late complications occurred in 20.4% of PC cases and 15.1% of DC controls (P = .25). Median survival was 210 days for PC cases and 272 days for DC controls (P = .25). Outcomes were similar for the subgroup of PC cases whose cancer extended to within 2 cm of the UES.
  
  
  CONCLUSIONS
  An important limitation is the absence of adequate follow-up data for 58 of the 151 case-control pairs.
  
  
  CONCLUSIONS
  SEMSs effectively palliate dysphagia in PC cases, whereas complication and survival rates are not statistically different from those of DC controls.
authors.affiliation: Tenwek Hospital, Bomet, Kenya. rparker3@lifespan.org
authors.forename: Robert K
authors.initials: RK
authors.lastname: Parker
authors.forename: Russell E
authors.initials: RE
authors.lastname: White
authors.forename: Mark
authors.initials: M
authors.lastname: Topazian
authors.forename: Robert
authors.initials: R
authors.lastname: Chepkwony
authors.forename: Sonja
authors.initials: S
authors.lastname: Dawsey
authors.forename: Felicity
authors.initials: F
authors.lastname: Enders
mesh_terms: D000230:Adenocarcinoma / Q000628:therapy*; D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000628:therapy*; D016022:Case-Control Studies; D003680:Deglutition Disorders / Q000209:etiology / Q000628:therapy*; D004938:Esophageal Neoplasms / Q000150:complications / Q000628:therapy*; D004939:Esophageal Perforation / Q000209:etiology; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D011446:Prospective Studies; D012720:Severity of Illness Index; D015607:Stents / Q000009:adverse effects; D015996:Survival Rate