Low morbidity after palliation of obstructing gastro-oesophageal adenocarcinoma to restore swallowing function.
BACKGROUND
This study describes the procedure-related complications and survival after deployment of self-expanding metal stents (SEMS) or use of argon plasma coagulation (APC) in patients with obstructing gastro-oesophageal junction (GEJ) adenocarcinoma.


METHODS
During an 8-year period, 312 patients with non-resectable, obstructing adenocarcinoma at the GEJ were treated with SEMS and/or APC and thereafter followed with endoscopies.


RESULTS
A total of 707 procedures (246 SEMS procedures and 461 ablations) were performed. No patients died in relation to the procedures. Minor bleeding during APC was seen in 20 patients. Early complications to SEMS were migration and misplacement. A single perforation with the guide-wire was seen. Late complications were tumour overgrowth and food impaction. A single treatment with SEMS or APC was performed in 115 (37%) and 49(16%) patients, respectively. SEMS replacement was necessary in 17 (5%) patients. Repeated APC treatments were necessary in 57 (18%) patients. The median time of survival in patients treated with SEMS, APC or both procedures was 134 days, 114 days and 215 days (p = 0.004), respectively. The survival in patients palliated with SEMS and/or APC alone was significantly lower compared to those who were palliated with SEMS and/or APC in combination with chemoradiotherapy. The median time of survival was 120 days in SEMS and 203 days in APC patients (p = 0.05).


CONCLUSIONS
SEMS and APC are safe treatment options for restoration of the swallowing function in patients with obstructing GEJ adenocarcinoma. SEMS or APC are equivalent treatment modalities in terms of survival.
Kirurgisk Afdeling C, Rigshospitalet, 2100 Copenhagen, Denmark. steenkofoed@hotmail.com
Steen Christian
SC
Kofoed
Martin
M
Lundsgaard
Ann-Camilla
AC
Ellemann
Lars Bo
LB
Svendsen
D000230:Adenocarcinoma / Q000150:complications / Q000628:therapy*; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D057908:Argon Plasma Coagulation / Q000009:adverse effects*; D000069287:Capecitabine; D016190:Carboplatin / Q000627:therapeutic use; D059248:Chemoradiotherapy; D003131:Combined Modality Therapy; D003680:Deglutition Disorders / Q000209:etiology / Q000628:therapy; D003841:Deoxycytidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D000077143:Docetaxel; D004938:Esophageal Neoplasms / Q000150:complications / Q000628:therapy*; D004939:Esophageal Perforation / Q000209:etiology; D004943:Esophagogastric Junction; D005260:Female; D005472:Fluorouracil / Q000031:analogs & derivatives / Q000627:therapeutic use; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D011475:Prosthesis Failure; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects*; D043823:Taxoids / Q000627:therapeutic use
D000970:Antineoplastic Agents; D043823:Taxoids; D003841:Deoxycytidine; D000077143:Docetaxel; D000069287:Capecitabine; D016190:Carboplatin; D005472:Fluorouracil