title: Self-expanding covered metallic stent as a bridge to surgery in esophageal cancer: impact on oncologic outcomes.
abstract: BACKGROUND
  Self-expanding metallic stents (SEMSs) have been used as a bridge to surgery, relieving dysphagia and maintaining nutrition, in patients with operable but obstructive esophageal cancer (EC). However, the impact of SEMSs on oncologic outcomes is unknown. The aim of this study was to evaluate the impact of SEMS insertion before EC surgery on oncologic outcomes.
  
  
  METHODS
  From 2000 to 2010, two thousand nine hundred and forty-four patients who underwent an operation for EC with a curative intent were included in a multicenter European cohort. Through propensity score analysis, patients who underwent SEMS insertion (SEMS group, n = 38) were matched 1:4 to control patients who did not undergo SEMS insertion (control group, n = 152).
  
  
  RESULTS
  The SEMS and control groups were comparable according to age, sex, tumor location, clinical stage, American Society of Anesthesiologists score, dysphagia, malnutrition, neoadjuvant treatment administration, histology, and surgical procedure. Self-expanding metallic stent insertion was complicated by tumoral perforation in 2 patients. The in-hospital postoperative mortality and morbidity rates for the SEMS vs control groups were 13.2% vs 8.6% (p = 0.370) and 63.2% vs 59.2% (p = 0.658), respectively. The R0 resection rate (71.0% vs 85.5%; p = 0.041), median time to recurrence (6.5 vs 9.0 months; p = 0.040), and 3-year overall survival (25% vs 44%; p = 0.023) were significantly reduced in the SEMS group, and the 3-year locoregional recurrence rate was increased (62% vs 34%; p = 0.049). The results remained significant after excluding SEMS-related esophageal perforations. After adjusting for confounding factors, SEMS insertion was a predictor of poor prognosis (hazard ratio = 1.6; p = 0.038).
  
  
  CONCLUSIONS
  Self-expanding metallic stent insertion, as a bridge to surgery, has a negative impact on oncologic outcomes in EC. Clinicaltrials.gov ID: NCT 01927016.
authors.affiliation: Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, Lille, France; North of France University, Lille, France; Inserm, UMR837, Team 5 "Mucins, Epithelial Differentiation and Carcinogenesis", Jean Pierre Aubert Research Center, Lille, France; SIRIC OncoLille, Lille, France. Electronic address: christophe.mariette@chru-lille.fr.
authors.forename: Christophe
authors.initials: C
authors.lastname: Mariette
authors.affiliation: Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, Lille, France; North of France University, Lille, France; Inserm, UMR837, Team 5 "Mucins, Epithelial Differentiation and Carcinogenesis", Jean Pierre Aubert Research Center, Lille, France.
authors.forename: Caroline
authors.initials: C
authors.lastname: Gronnier
authors.affiliation: SIRIC OncoLille, Lille, France; Department of Biostatistics, University Hospital, Lille, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Duhamel
authors.affiliation: Departments of Digestive Surgery of Croix-Rousse University Hospital, Lyon, France.
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Mabrut
authors.affiliation: Cavale Blanche University Hospital, Brest, France.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Bail
authors.affiliation: Purpan University Hospital, Toulouse, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Carrere
authors.affiliation: Saint Antoine University Hospital, Paris, France.
authors.forename: Jérémie H
authors.initials: JH
authors.lastname: Lefevre
authors.affiliation: Pontchaillou University Hospital, Rennes, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Meunier
authors.affiliation: Haut-Levêque University Hospital, Bordeaux, France.
authors.forename: Denis
authors.initials: D
authors.lastname: Collet
authors.affiliation: Department of Digestive and Oncological Surgery, Claude Huriez University Hospital, Lille, France; North of France University, Lille, France; Inserm, UMR837, Team 5 "Mucins, Epithelial Differentiation and Carcinogenesis", Jean Pierre Aubert Research Center, Lille, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Piessen
mesh_terms: D000230:Adenocarcinoma / Q000150:complications / Q000401:mortality / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000401:mortality / Q000601:surgery*; D003680:Deglutition Disorders / Q000209:etiology / Q000628:therapy*; D004938:Esophageal Neoplasms / Q000150:complications / Q000401:mortality / Q000601:surgery*; D016629:Esophagectomy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods*; D057216:Propensity Score; D012189:Retrospective Studies; D015607:Stents; D016019:Survival Analysis; D016896:Treatment Outcome