Esophageal stents during neoadjuvant therapy

Stents are widely used in the palliative treatment of esophageal malignant diseases for dysphagia. Their safety and efficacy in the curative neoadjuvant setting while induction therapy is underway have not been established. Concerns have been raised about a low frequency of curative surgery and poor survival outcomes when stenting has been used as a pathway to neoadjuvant therapy.

A systematic review was undertaken to identify patients with esophageal cancer undergoing stent implantation before or during neoadjuvant chemotherapy, where curative intent resection was planned, from 1949 to December 2014. The primary outcome was survival and secondary outcomes were adverse events and progression to resection. The event rate and confidence intervals (CIs) were calculated.

Our literature search identified 425 potentially relevant reports and articles on patients who had undergone stenting in neoadjuvant therapy, of which 14 studies (n = 430 patients) met the inclusion criteria for analysis. A total of 430 patients were identified undergoing stenting and neoadjuvant therapy with intention to cure. Resection was determined in 250 patients in a highly heterogeneous group and was achieved in 46.9% of patients (95% CI: 22.8–71.8). The variability of the resection proportion in the reports was very wide. Adequate data evaluating complete resection were available only in five studies. Upon intention to treat for cure, there were enough data from 119 patients to assess resection, of whom 56 eventually had complete surgical excision (i.e., 47%). The rate of resection was also highly heterogeneous (p < 0.0001, 95% CI: 86.86–96.38) and the total random effects was 35.3% (95% CI: 8.3–68.9)

Esophageal stenting in the neoadjuvant setting cannot be supported or rejected by the current data.