Survival and complications after insertion of self-expandable metal stents for malignant oesophageal stenosis.

OBJECTIVE: To report on survival and complications after insertion of self-expandable stents in patients with malignant oesophageal stenosis. MATERIAL AND METHODS: Data were gathered retrospectively from the medical records of 92 consecutive patients in the period 1994-2003. The study comprised 68 men and 24 women (median age 72 years, range 46-93 years) with stenosis from cancer of the oesophagus (n=61), the gastric cardia (n=26) and the lung (n=5), located mainly above (n=4) or below (n=62) the carina, or at the gastro-oesophageal junction (n=26). One uncovered stent and six different covered stents were used. RESULTS: Median and mean survival times after stenting (n=92) were 83 (range 4-1102) and 125 days, respectively. Thirty-day mortality was 19% (n=17), and 7% (n=6) survived more than one year. Survival was neither significantly influenced by division of the patients into diagnostic subgroups nor by comparison of the three most frequently used stents. One, two, three and four stents were received by 76, 11, 4 and 1 patient(s), respectively. There was no stent-related mortality, and complications were bleeding 1 (1%), stent migration 7 (8%), recurrent stenosis 8 (9%) from both tumour overgrowth (n=8) and tumour ingrowth (n=2) when using uncovered stents. Thirteen (14%) patients were re-stented because of recurrent stenosis (n=8) including fistula formation to the left main bronchus (n=2) and stent migration (n=5). CONCLUSIONS: Use of self-expandable stents in patients with inoperable malignant oesophageal stenosis carried few complications and resulted in relatively long survival in comparison with similar studies.

[Surgery and stenting for oesophageal cancer]. / Kirurgi og stenting for cancer oesophagi.

BACKGROUND: The purpose of this study was to evaluate the results of surgery and stenting for operable and inoperable oesophageal cancer. MATERIAL AND METHODS: Retrospective patient materials with resection (n = 65, 1983-2002) or stenting (n = 59, 1994-2003) for primary oesophageal cancer. RESULTS: Mortality after surgery was 11% and 15% of the patients were re-operated. 36 (55%) had complications such as respiratory failure (n = 33), anastomotic dehiscence/perforation (n = 4), chylothorax (n = 1), haemorrhage (n = 3), wound rupture (n = 1), septicaemia (n = 2), arrhythmia (n = 4) and wound infection (n = 5). Median survival after surgery was 11 months. Survival after three years was 17%, after five years 8%. The stent procedure was without mortality but haemorrhage (n = 1) and stent dislocation (n = 2) occurred. 8 patients (14%) were re-stented for tumour stenosis (n = 6), fistula (n = 2) and dislocation (n = 1). Median survival after stenting was 78 days. Survival after 30 days was 80%, after one year 7%. INTERPRETATION: Resectable oesophageal cancer should be operated in fit patients, as survival is improved and some patients can be cured. Stenting is the main option in inoperable patients.