A bridging stent to surgery in patients with esophageal and gastroesophageal junction cancer has a dramatic negative impact on patient survival

Abstract

This study aimed to assess the impact of esophageal stenting on postoperative complications and survival in patients with obstructing esophageal and gastroesophageal junction (GEJ) cancer. All patients treated without neoadjuvant therapy that had an R0-resection performed for esophageal and GEJ cancer between January 2003 and December 2010 were identified from a prospectively maintained database. Data on stenting, postoperative mortality, morbidity, recurrence-free survival, complications, and length of hospital stay were collected. Kaplan-Meier plots for survival and recurrence-free survival curves were constructed for R0 resected patients. Data were compared between the stent and no-stent group by nonparametric tests. Two hundred seventy three consecutive R0 resected patients with esophageal or GEJ cancer were identified. Of these patients, 63 had a stent as a bridge to surgery. The male/female ratio was 2.64 (198/75) with a median age in the stent group (SG) of 65.1 versus 64.3 in the no stent group (NSG). Patients were comparable with respect to gender, age, smoking, TNM-classification, oncological treatment, hospital stay, tumor location, and histology. The median survival in the SG was 11.6 months compared with 21.3 months for patients treated without a bridging stent (P < 0.001). There were no statistically significant differences in 30-day mortality between the two groups, but NSG patients exhibited a significantly better two-year survival (P = 0.017). The median recurrence-free survival was 9.1 months for the SG compared with 15.2 months for the NSG. The use of a stent as a bridging procedure to surgery in patients treated without neaoadjuvant therapy for an esophageal or GEJ cancer that later underwent R0 resection decreased the two year survival and the recurrence-free survival.

Stenting for Advanced Esophageal Carcinoma

“…Despite its usefulness in palliating symptoms, the use of bridge SEMS placement has a negative impact on oncological outcomes according to recent studies. [27][28][29] Mariette et al 28 reported that patients who underwent SEMS placement as bridging therapy had earlier recurrence (7 vs. 9 months) and a lower 3-year overall survival rate (25 vs. 44%). Increased incidence of SEMSrelated complications, mechanical injury caused by SEMS, Fig.…”

Self-Expandable Metallic Stent Placement for the Palliation of Esophageal Cancer

“…SEMS placement has been increasingly used as a “bridging therapy” to surgery, improving dysphagia and allowing for oral nutrition during neoadjuvant therapy ( 29 ). However, according to recent studies, the use of SEMS placement as bridging therapy has a negative impact on oncological outcomes ( 42 43 44 ). Mariette et al ( 43 ) reported in their cohort of 2,944 patients that those who underwent SEMS placement as bridging therapy had a lower median time to recurrence (7 vs. 9 months; P = 0.040) and a lower 3-year overall survival rate (25% vs. 44%; P = 0.023).…”

“…Complications of SEMS placement can also be classified as major and minor. Major complications are life-threatening conditions such as ERF, bleeding, and perforation; minor complications are those that are not life-threatening, including migration, tumor ingrowth and overgrowth, and food impaction ( 3 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 ).…”

PSMD4 regulates the malignancy of esophageal cancer cells by suppressing endoplasmic reticulum stress

“…Esophageal cancer (EC) is one of the most common malignant tumors in the gastrointestinal tract . According to the WHO histological classification, EC mainly comprises squamous cell carcinoma (SCC) and esophageal adenocarcinoma, of which the proportion of SCCs is as high as 90% .…”

“…Esophageal cancer (EC) is one of the most common malignant tumors in the gastrointestinal tract. 1,2 According to the WHO histological classification, EC mainly comprises squamous cell carcinoma (SCC) and esophageal adenocarcinoma, of which the proportion of SCCs is as high as 90%. 3,4 In China, it is estimated that the average annual death total due to EC is~150 thousand people, which accounts for 21.8% of all cancer mortalities.…”