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Temporary placement of self-expanding oesophageal stents as bridging for neo-adjuvant therapy.

AbstractBACKGROUND:
Placement of self-expanding stents is an effective palliation for dysphagia in non-resectable oesophageal or proximal gastric cancer. The aim of this analysis was to assess the efficacy of temporary stent placement for dysphagia relief during neo-adjuvant treatment for locally advanced disease.
METHODS:
A total of 38 patients scheduled for neo-adjuvant chemo(radio)therapy for locally advanced oesophageal cancer (n = 29), cardia cancer (n = 8) or subcardial gastric cancer (n = 1) underwent placement of self-expanding plastic stents (n = 13) or covered metal stents (n = 25) due to severe dysphagia and weight loss.
RESULTS:
Instant dysphagia relief was achieved in 37 (97.4%) of 38 patients. Dysphagia scores declined from mean 3.0 +/- 0.7 before stent placement to 0.6 +/- 0.9 at restaging. After completion of the neo-adjuvant therapy 20 (52.6%) of the 38 patients underwent resection of the tumour, 5 patients (13.2%) underwent primary resection without receiving chemotherapy while 12 patients (31.6%) did not undergo surgery. Stent-related complications were observed as perforation (n = 1), mediastinitis (n = 1), tracheo-oesophageal fistula (n = 2), bleeding (n = 1) and jejunal perforation caused by a migrated stent (n = 1). Serum albumin significantly decreased in patients with progressive disease despite successful stenting (40.0 +/- 4.9 mg/dl versus 29.7 +/- 6.4 mg/dl, p < 0.05) while stable albumin levels were found in patients who underwent surgery (39.9 +/- 4.3 mg/dl versus 39.1 +/- 3.8 mg/dl, p = 0.484).
CONCLUSION:
Placement of self-expanding stents is highly effective for instant dysphagia relief, enabling adequate oral nutrition during neo-adjuvant therapy, but is limited by a high re-intervention rate.
AuthorsFelix B Langer, Sebastian F Schoppmann, Gerhard Prager, Florian Tomaselli, Ursula Pluschnig, Michael Hejna, Rainer Schmid, Johannes Zacherl
JournalAnnals of surgical oncology (Ann Surg Oncol) Vol. 17 Issue 2 Pg. 470-5 (Feb 2010) ISSN: 1534-4681 [Electronic] United States
PMID19859771 (Publication Type: Journal Article)
Topics
  • Adenocarcinoma (pathology, therapy)
  • Adult
  • Aged
  • Aged, 80 and over
  • Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
  • Cardia (drug effects, radiation effects, surgery)
  • Combined Modality Therapy
  • Deglutition Disorders (etiology, surgery)
  • Esophageal Neoplasms (pathology, therapy)
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Neoadjuvant Therapy
  • Neoplasms, Squamous Cell (pathology, therapy)
  • Palliative Care
  • Radiotherapy Dosage
  • Stents
  • Survival Rate
  • Treatment Outcome

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