P-046 - Follow-up results of expandable metal stents for malignant esophageal obstruction in 210 cases

Date 04 July 2015
Event WorldGI 2015
Session Posters
Topics Oesophageal Cancer
Palliative Care
Surgery and/or Radiotherapy of Cancer
Presenter H.S. Moon
Citation Annals of Oncology (2015) 26 (suppl_4): 1-100. 10.1093/annonc/mdv233
Authors H.S. Moon1, J.S. Kim2, S.H. Kang1, J.K. Sung1, H.Y. Jeong1
  • 1Chungnam National University College of Medicine, Daejeon/KR
  • 2Chungnam National University School of Medicine, Daejeon/KR

Abstract

Introduction

Palliation of malignant esophageal obstruction endoscopically placed stent has been shown to improve patient quality of life by allowing restoration of oral alimentation. But complications and failures have not been well described in stomach cancer with esophageal invasion as well as esophageal and lung cancer. The aim of this report was to summarize our experience with expandable metal stents for palliative malignant esophageal obstruction in 210 cases and also compared the clinical outcomes of patients with esophageal, lung and stomach cancer with esophageal invasion.

Methods

During January 2000 and December 2012, 210 stents were placed in 183 patients with malignant esophageal obstruction from esophageal cancer, lung cancer or stomach cancer with esophageal invasion. Dysphagia grade, clinical outcome, complications, and risk factor of complications were evaluated.

Results

Esophageal cancer group was 109 of 210 cases (51.9%), lung cancer group was 31 to 210 cases (14.8%), and stomach cancer with esophageal invasion group was 70 to 210 cases (33.3%). The improvement in dysphagia grade after stent implantation was statistically significant (from 3.2 to 1.8, P <0.001). Complication occurred in 23 (11%) patients. Procedure-related mortality was 2.4% (5/210). Tumor ingrowth and overgrowth is a significant problem with stent insertion, occurring in 53 patients (29%). And bleeding, sepsis due to procedure is more serious complication in the patients with malignant dysphagia, and mortality rate is high. When comparing the esophageal, lung, and stomach cancer groups, fistula status (p < 0.001), and migration (p = 0.017) were significantly different from each other. But there were no significant risk factors between complication and non-complication group. Complications were not correlated to type of tumor characteristics (p = 0.176).

Conclusion

Expandable metal stents offer excellent palliation of malignant obstruction. Placement of the expandable metal stents effectively relieved malignant dysphagia in treated patients. Several factors should be considered before applying palliative therapy for malignant esophageal obstruction. Tumor characteristics such as location, fistula, and type need to be considered. Factors such as medical comorbidity and overall expected duration of survival also are important.