Preliminary Results of Temporary Placement of Retrievable Expandable Metallic Stents during Preoperative Neoadjuvant Chemoradiotherapy in Patients with Resectable Esophageal Cancer.

Abstract

PURPOSE:

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.

MATERIALS AND 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.

• Authors: Jung-Hoon Park, Ho-Young Song, Ji Hoon Shin, Jin Hyoung Kim, Yong Hee Kim, Sung Bae Kim, Jong-Hoon Kim
• Journal: Journal of vascular and interventional radiology : JVIR (J Vasc Interv Radiol) Vol. 26 Issue 6 Pg. 883-8 (Jun 2015) ISSN: 1535-7732 [Electronic] United States
• PMID: 25724088 (Publication Type: Journal Article)
• Copyright: Copyright © 2015 SIR. Published by Elsevier Inc. All rights reserved.

Chemical References

• Metals

Topics

• Aged
• Aged, 80 and over
• Carcinoma, Squamous Cell (complications, pathology, therapy)
• Chemoradiotherapy, Adjuvant
• Deglutition Disorders (diagnosis, etiology, therapy)
• Device Removal
• Esophageal Neoplasms (complications, pathology, therapy)
• Esophageal Squamous Cell Carcinoma
• Esophagectomy
• Female
• Foreign-Body Migration (etiology)
• Humans
• Kaplan-Meier Estimate
• Male
• Metals
• Middle Aged
• Neoadjuvant Therapy
• Palliative Care
• Prosthesis Design
• Retrospective Studies
• Risk Factors
• Severity of Illness Index
• Stents (adverse effects)
• Time Factors
• Treatment Outcome