Most patients with esophageal
carcinoma present in the advanced stage die from
tumor invasion and widespread
metastases. Because radical regimens are not appropriate for the majority of patients, and their expected survivals are as short as to be measured by months, the main aim of
therapy is palliation with minimum morbidity and mortality. Among the palliative modalities are surgery, external
radiotherapy or
brachytherapy, dilatation,
laser,
photodynamic therapy, bipolar
electrocoagulation tumor probe, and chemical ablation. The placement of
self-expandable metallic stents is another method that improves
dysphagia for these patients. In this study, the aim was to evaluate retrospectively the effectiveness of metallic
stents deployed because of inoperable malignant
esophageal stenosis and
esophagotracheal fistulas. The results of 170 patients with 202
stents administered because of inoperable malignant
esophageal stenosis and esophagorespiratory
fistula between January 2000 and October 2008 at the Ataturk University, Department of Thoracic Surgery, were investigated. Despite epidemiological and clinical data, information regarding relief of
dysphagia and quality of life were also examined. One hundred seventy patients with
stents were between 28 and 91 years old (mean age 63.7 years+/-11.4 years). Ninety-seven were male and 73 were female.
Stent indications were advanced
tumors with distant
metastasis (82 cases, 48.2%), unresectable
tumors (51 cases, 30%), patients who cannot tolerate surgery or
chemoradiotherapy (18 cases, 10.5%), local recurrence after primary
therapy (1 case, 0.5%), esophagorespiratory
fistulas from
tumor or
therapy (14 cases, 8.2%), and refusal of surgery (4 cases, 2.3%).
Dysphagia scores evaluated by a modified Takita's grading system improved from 3.4 before the procedure to 2.6 afterward. The overall complication rate without
chest pain was 31.7% (occurring in 64 cases). Mean survival was 177.7 days+/-59.3 days (2-993 days). Quality-of-life scores (The European Organization of Research and Treatment of
Cancer QLQ C30) improved from 73+/-10.3 (57-85) to 112+/-12.6 (90-125). In
therapy of malignant esophageal obstructions, metallic
stents provide a significant improvement in
dysphagia and require less frequent re-intervention according to other methods of
dysphagia palliation such as dilatation,
laser, and
photodynamic therapy, nearly completely relieve
esophagotracheal fistulas and improve quality of life to an important degree.