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Temporary Placement of Self-Expanding Oesophageal Stents as Bridging for Neo-Adjuvant Therapy

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

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.

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Correspondence to Johannes Zacherl MD.

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Langer, F.B., Schoppmann, S.F., Prager, G. et al. Temporary Placement of Self-Expanding Oesophageal Stents as Bridging for Neo-Adjuvant Therapy. Ann Surg Oncol 17, 470–475 (2010). https://doi.org/10.1245/s10434-009-0760-6

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  • DOI: https://doi.org/10.1245/s10434-009-0760-6

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