title: A bridging stent to surgery in patients with esophageal and gastroesophageal junction cancer has a dramatic negative impact on patient survival: A retrospective cohort study through data acquired from a prospectively maintained national database.
abstract: This study aimed to assess the impact of esophageal stenting on postoperative complications and survival in patients with obstructing esophageal and gastroesophageal junction (GEJ) cancer. All patients treated without neoadjuvant therapy that had an R0-resection performed for esophageal and GEJ cancer between January 2003 and December 2010 were identified from a prospectively maintained database. Data on stenting, postoperative mortality, morbidity, recurrence-free survival, complications, and length of hospital stay were collected. Kaplan-Meier plots for survival and recurrence-free survival curves were constructed for R0 resected patients. Data were compared between the stent and no-stent group by nonparametric tests. Two hundred seventy three consecutive R0 resected patients with esophageal or GEJ cancer were identified. Of these patients, 63 had a stent as a bridge to surgery. The male/female ratio was 2.64 (198/75) with a median age in the stent group (SG) of 65.1 versus 64.3 in the no stent group (NSG). Patients were comparable with respect to gender, age, smoking, TNM-classification, oncological treatment, hospital stay, tumor location, and histology. The median survival in the SG was 11.6 months compared with 21.3 months for patients treated without a bridging stent (P < 0.001). There were no statistically significant differences in 30-day mortality between the two groups, but NSG patients exhibited a significantly better two-year survival (P = 0.017). The median recurrence-free survival was 9.1 months for the SG compared with 15.2 months for the NSG. The use of a stent as a bridging procedure to surgery in patients treated without neaoadjuvant therapy for an esophageal or GEJ cancer that later underwent R0 resection decreased the two year survival and the recurrence-free survival.
authors.affiliation: Department of Surgery, Aarhus University Hospital, Aarhus , Denmark
authors.forename: D W
authors.initials: DW
authors.lastname: Kjaer
authors.affiliation: Department of Surgery, Aarhus University Hospital, Aarhus , Denmark
authors.forename: M
authors.initials: M
authors.lastname: Nassar
authors.affiliation: Department of Surgery, Aarhus University Hospital, Aarhus , Denmark
authors.forename: L S
authors.initials: LS
authors.lastname: Jensen
authors.affiliation: Department of Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
authors.forename: L B
authors.initials: LB
authors.lastname: Svendsen
authors.affiliation: Department of Surgery, Aarhus University Hospital, Aarhus , Denmark
authors.forename: F V
authors.initials: FV
authors.lastname: Mortensen
mesh_terms: D000368:Aged; D003131:Combined Modality Therapy; D016208:Databases, Factual; D018572:Disease-Free Survival; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods / Q000401:mortality*; D004943:Esophagogastric Junction / Q000473:pathology / Q000601:surgery*; D004945:Esophagoscopy / Q000295:instrumentation* / Q000401:mortality; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000209:etiology / Q000401:mortality; D009367:Neoplasm Staging; D011446:Prospective Studies; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D015607:Stents / Q000009:adverse effects*; D016896:Treatment Outcome
keywords: GEJ cancer; GI surgery; cancer esophagus; esophageal stents; esophageal surgery; esophagectomy; esophagogastric junction cancer