Preliminary Results of Temporary Placement of Retrievable Expandable Metallic Stents during Preoperative Neoadjuvant Chemoradiotherapy in Patients with Resectable Esophageal Cancer.
OBJECTIVE
To evaluate the clinical efficacy of temporary placement of a retrievable expandable metallic stent (REMS) during preoperative neoadjuvant chemoradiotherapy (CRT) in patients with resectable esophageal cancer.


METHODS
REMSs were placed in 25 patients who underwent preoperative neoadjuvant CRT for resectable esophageal cancer. Stent removal was scheduled between 4 and 6 weeks after starting neoadjuvant CRT. Clinical effectiveness was assessed using the following variables: technical and clinical success, dysphagia score before and after stent placement and removal, and complications and their management.


RESULTS
REMS placement was technically successful in all patients, with 24 of 25 patients (96%) showing symptomatic improvement. Stents were removed electively 32 days (range, 27-42 d) after starting neoadjuvant CRT (n = 20; 80%) or after stent migration and exit through the anus with no evidence of symptom recurrence (n = 5; 20%). The dysphagia score (before stent, 3.1 ± 0.5) improved by 3 days after stent placement (1.3 ± 0.4; P < .001) and was maintained up to 1 month after stent removal (1.2 ± 0.7; P < .001). The median survival was 18.6 months.


CONCLUSIONS
In patients with resectable esophageal cancer, temporary placement of a REMS during preoperative neoadjuvant CRT showed clinical efficacy in the bridge to surgery. Stent removal between 4 and 6 weeks after starting neoadjuvant CRT seems to be a feasible time frame with symptom improvement.
Departments of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, 388-1, Poongnap 2-dong, Songpa-gu, Seoul, 138-736, Republic of Korea; Thoracic and Cardiovascular Surgery, University of Ulsan College of Medicine, 388-1, Poongnap 2-dong, Songpa-gu, Seoul, 138-736, Republic of Korea.
Jung-Hoon
JH
Park
Departments of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, 388-1, Poongnap 2-dong, Songpa-gu, Seoul, 138-736, Republic of Korea. Electronic address: hysong@amc.seoul.kr.
Ho-Young
HY
Song
Departments of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, 388-1, Poongnap 2-dong, Songpa-gu, Seoul, 138-736, Republic of Korea.
Ji Hoon
JH
Shin
Departments of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, 388-1, Poongnap 2-dong, Songpa-gu, Seoul, 138-736, Republic of Korea.
Jin Hyoung
JH
Kim
Thoracic and Cardiovascular Surgery, University of Ulsan College of Medicine, 388-1, Poongnap 2-dong, Songpa-gu, Seoul, 138-736, Republic of Korea.
Yong Hee
YH
Kim
Internal Medicine, University of Ulsan College of Medicine, 388-1, Poongnap 2-dong, Songpa-gu, Seoul, 138-736, Republic of Korea.
Sung Bae
SB
Kim
Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap 2-dong, Songpa-gu, Seoul, 138-736, Republic of Korea.
Jong-Hoon
JH
Kim
D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000150:complications / Q000473:pathology / Q000628:therapy*; D059186:Chemoradiotherapy, Adjuvant; D003680:Deglutition Disorders / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D020878:Device Removal; D004938:Esophageal Neoplasms / Q000150:complications / Q000473:pathology / Q000628:therapy*; D000077277:Esophageal Squamous Cell Carcinoma; D016629:Esophagectomy; D005260:Female; D005548:Foreign-Body Migration / Q000209:etiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008670:Metals; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D010166:Palliative Care; D011474:Prosthesis Design; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D015607:Stents / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome
D008670:Metals