The use of self-expanding metallic stents (SEMS) is effective in symptom palliation from recurrent tumor after esophagogastrectomy for cancer

Abstract

The efficacy of using self-expanding metallic stent (SEMS) for palliation of symptoms because of tumor recurrence after prior esophagogastrectomy has not been properly assessed despite the well recognized use of SEMS in patients without prior surgery. The aim of this study is to evaluate the efficacy and safety of using SEMS in patients who had prior esophagogastrectomy. The study group included 35 patients with carcinoma of esophagus or cardia documented to have loco-regional recurrence after esophagogastrectomy and in whom SEMS were placed for palliation. The median age was 67 (ranged 41-85). The indications for stenting were dysphagia caused by recurrence at the esophageal anastomosis (n= 4) and in the esophageal remnant (n= 5), or extrinsic compression from mediastinal nodal disease (n= 7); gastric outlet obstruction produced by extrinsic tumor compression (n= 13); and tracheo-esophageal fistulae (n= 6). Forty-three stenting procedures were performed, and the technical success rate was 97.6%. The dysphagia score improved from 4.66 to 2.54 (P < 0.001). All patients with tracheo-esophageal fistula had their symptoms successfully palliated. The immediate complication rate was 14% (n= 5); two patients had stent malpositioning, two had inadequate opening of their stents, and one had a failed stenting procedure. On follow-up, 15 (42.8%) patients required a total of 22 re-intervention procedures for various reasons: endoscopic dilatation (five dilatations in three patients), removal of foreign bodies (nine procedures in four patients), and insertion of a second SEMS related to tumor growth (eight stents in eight patients). There was no procedure-related mortality. The median survival was short at 42 days (range 5-290 days), mostly related to advanced disease stage. SEMS in patients with recurrent tumor after esophagogastrectomy is safe and effective.

Palliation of Dysphagia in Carcinoma Esophagus

“…Patients can also be benefited from SEMS placement in cases of local recurrence after esophagogastrectomy, providing palliation of dysphagia and symptom relief from tracheoesophageal fistula. Tong et al 26 placed 43 esophageal stents in 35 patients who presented with dysphagia secondary to locoregional recurrence of carcinoma after prior esophagogastrectomy for carcinoma esophagus. A total of 97.6% success rate was seen after stent placement with dysphagia score, which reduced to 2.54 from a previous score of 4.66.…”

The Current Role of Endoscopic Stenting in Upper Gastrointestinal Surgery

“…Minor procedure complications which lead to morbidity were seen up to 40% in various series. [14,15] Intra-procedure complications such as aspiration, sedation risk, malposition of the stent, bleeding and perforation could occur. Early complications may include chest pain, bleeding or tracheal compression.…”