title: Preoperative stenting in oesophageal cancer has no effect on survival: a propensity-matched case-control study.
abstract: OBJECTIVE
  Previous studies have shown a link between oesophageal stenting before oesophagectomy and worse oncological outcomes. Our objective was to determine the effect of preoperative self-expanding covered metallic stent (SEMS) on survival, progression-free survival (PFS), operative time and complication rates in oesophageal cancer (EC).
  
  
  METHODS
  This study included EC patients undergoing surgery between January 2006 and January 2014 with a cT2 tumour or higher ( n  = 174; 135 adenocarcinomas and 39 squamous cell carcinomas). We propensity matched 1:1 a preoperative SEMS group ( n  = 30) to a control group. Despite the propensity matching, statistically non-significant residual covariate imbalances persisted. Median follow-up time was 33 months (range: 0-118 months). We performed Kaplan-Meier survival analysis for OS and PFS, the Student's t -test for operative time and the chi-squared test for complication rates.
  
  
  RESULTS
  Median survival in the SEMS group was 28.5 months (range: 0-116 months) vs 34 months (4-118 months) in the control group and median PFS was 22 months (0-111 months) vs 27 (4-113 months) ( P  = 0.748 and P  = 0.764, respectively). Mean operative times between groups were 436 min vs 375 min ( P  = 0.017). No differences emerged in intraoperative (23.3% vs 10%, P  = 0.299), early (50.0% vs 46.7%, P  = 1) or late complication rates (53.3% vs 43.3%, P  = 0.606).
  
  
  CONCLUSIONS
  SEMS application has no significant effect on survival, PFS or complications. Mean operative time was significantly higher in the SEMS insertion group. We therefore conclude that preoperative SEMS insertion makes the operation more challenging by increasing operative time, but is otherwise a feasible and safe strategy in experienced centres as a bridge to surgery.
authors.affiliation: Department of General Thoracic and Oesophageal Surgery, Heart and Lung Centre, Helsinki University Hospital, Helsinki, Finland.|Department of Surgery, Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
authors.forename: Tommi
authors.initials: T
authors.lastname: Järvinen
authors.affiliation: Department of General Thoracic and Oesophageal Surgery, Heart and Lung Centre, Helsinki University Hospital, Helsinki, Finland.|Department of Surgery, Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
authors.forename: Ilkka
authors.initials: I
authors.lastname: Ilonen
authors.affiliation: Department of Surgery, Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland.|Department of Anaesthesiology & Intensive Care, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Emmi
authors.initials: E
authors.lastname: Ylikoski
authors.affiliation: Department of Surgery, Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland.|Department of Anaesthesiology & Intensive Care, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Kaisa
authors.initials: K
authors.lastname: Nelskylä
authors.affiliation: Department of General Thoracic and Oesophageal Surgery, Heart and Lung Centre, Helsinki University Hospital, Helsinki, Finland.|Department of Surgery, Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
authors.forename: Juha
authors.initials: J
authors.lastname: Kauppi
authors.affiliation: Department of General Thoracic and Oesophageal Surgery, Heart and Lung Centre, Helsinki University Hospital, Helsinki, Finland.|Department of Surgery, Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
authors.forename: Jarmo
authors.initials: J
authors.lastname: Salo
authors.affiliation: Department of General Thoracic and Oesophageal Surgery, Heart and Lung Centre, Helsinki University Hospital, Helsinki, Finland.|Department of Surgery, Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
authors.forename: Jari
authors.initials: J
authors.lastname: Räsänen
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D004938:Esophageal Neoplasms / Q000401:mortality / Q000601:surgery; D016629:Esophagectomy / Q000009:adverse effects / Q000379:methods / Q000401:mortality / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications; D057216:Propensity Score; D015607:Stents / Q000009:adverse effects / Q000706:statistics & numerical data
keywords: Case-control study; Complications ; Oesophageal cancer ; Preoperative stenting ; Propensity matching ; Survival 