Efficacy and risk factor assessment of outcomes of self-expanding metal stents deployed in advanced oesophageal cancer: a case series of 69 patients from a tertiary referral centre of South India

Venkata Kapil Kishore Siddiraju; Ashok Kumar K. V.; Nagesh N. S.

doi:10.18203/2349-2902.isj20211292

Authors

Venkata Kapil Kishore Siddiraju Department of Surgical Gastroenterology and Liver Transplantation, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
Ashok Kumar K. V. Department of Surgical Gastroenterology and Liver Transplantation, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
Nagesh N. S. Department of Surgical Gastroenterology and Liver Transplantation, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India

DOI:

https://doi.org/10.18203/2349-2902.isj20211292

Keywords:

Adverse events, Oesophageal cancer, SEMS, Survival

Abstract

Background: In India, Oesophageal cancer ranks as the 6^th most common cause of cancer-related deaths. SCC is the most common histology with middle and lower third of the oesophagus as most common location. Often, it is diagnosed in elderly individuals with multiple comorbidities, and at an advanced stage with malignant strictures, where SEMS is treatment of choice. The current retrospective study aims to evaluate efficacy and the risk factor assessment of outcomes of SEMS deployment in patients with advanced oesophageal cancer.

Methods: All consecutive patients referred to Department of SGE and LT of BMCRI, with advanced oesophageal cancer from March 2012 to October 2019 were studied. Patients details viz. demography, dysphagia grade, stricture details and SEMS related adverse events and 30-day, 90-day and long-term mortality data was charted and significance of these study parameters along with survival analysis was carried out by using relevant statistical tools.

Results: Of the 69 patients, SCC in mid-oesophagus was the most common presentation. 36 patients (52.2%) received prior CRT, TEF (n=11) and distant metastasis (n=7). SEMS intention was palliation in all patients. Overall procedural success using 'Endoscopy alone' was achieved in all 69 patients (100%). Post SEMS period uneventful (n=36), transient haemorrhage (n=5) patients, aspiration (n=11), tumour overgrowth and ingrowth (n=11), SEMS on SEMS (n=5), double SEMS for TEF (n=2). Significant adverse events necessitating reinterventions were seen in 17 patients (24.5%). Kaplan-Meier graph showed lower survival in patients with metastasis and TEF and no statistical difference in-terms of adverse events was noted based on fully covered versus partially covered SEMS.

Conclusions: SEMS aids in early resumption of oral feeds and the outcomes of fully covered and partially covered SEMS are comparable in a palliative setting.

Metrics

Metrics Loading ...

References

Bray F, Ren JS, Masuyer E, Ferlay J. Estimates of global cancer prevalence for 27 sites in the adult population in 2008. Int J Cancer. 2013;132(5):1133- 45

Freddie B, Jacques F, Isabelle S, Rebecca SL, Lindsey TA, Ahmedin J. Global Cancer Statistics 2018: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. Cancer J Clin. 2018;68:394-424.

Pandey V, Choksi D, Kolhe K, Ingle M, Rathi C, Khairnar H, et al. Esophageal carcinoma: an epidemiological analysis and study of the time trends over the last 20 years from a single center in India. J Fam Med Prim Care. 2020;9(3):1695.

Ferlay JS, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, et al. Cancer incidence and mortality worldwide: IARC CancerBase. GLOBOCAN. 2012;2013(1):11.

Grotenhuis B, van Hagen P, Wijnhoven B, Spaander M, Tilanus H, van Lanschot J. Delay in diagnostic workup and treatment of esophageal cancer. J Gastrointest Surg. 2009;14(3):476-83.

Sabharwal T, Morale JP, Irani FG, Adam A. Quality improvement guidelines for placement of esophageal stents. Cardiovasc Intervent Radiol. 2005;28:284-8.

Katsanos K, Ahmad F, Dourado R, Sabharwal T, Adam A. Interventional radiology in the elderly. Clin Intervent Aging. 2009;4:1.

Burstein HJ, Mayer RJ. Gastrointestinal cancer. In: Hunter CP, Johnson KA, Muss HD. eds. Cancer in the elderly. Marcel Dekker Inc., New York; 2000:325-328.

Enzinger PC, Mayer RJ. Esophageal cancer. N Engl J Med. 2003;349:2241-52.

Domschke W, Foerster EC, Matek W, Rödl W. Self-expanding mesh stent for esophageal cancer stenosis. Endoscopy. 1990;22(03):134-6.

Siersema P. Treatment options for esophageal strictures. Nat Clin Pract Gastroenterol Hepatol. 2008;5(3):142-52.

Diamantis G. Quality of life in patients with esophageal stenting for the palliation of malignant dysphagia. World J Gastroenterol. 2011;17(2):144.

Baron T. Expandable metal stents for the treatment of cancerous obstruction of the gastrointestinal tract. N Engl J Med. 2001;344(22):1681-7.

Lowe A, Sheridan M. Esophageal stenting. Semin Intervent Radiol. 2004;21(03):157-66.

Adam A, Ellul J, Watkinson A, Tan B, Morgan R, Saunders M, et al. Palliation of inoperable esophageal carcinoma: a prospective randomized trial of laser therapy and stent placement. Radiology. 1997;202(2):344-8.

Kochar R, Shah N. Enteral stents: from esophagus to colon. Gastrointest Endosc. 2013;78(6):913-8.

Peters JH, Meester TR, Stein HJ. Surgical therapy for cancer of the esophagus and cardia. In: Castell DO, edn. The esophagus. 2nd edn. Little Brown: New York; 1995;293-335.

Kaplan E, Meier P. Nonparametric estimation from incomplete observations. J Am Statist Assoc. 1958;53(282):457-81.

Spaander M, Baron T, Siersema P, Fuccio L, Schumacher B, Escorsell À, et al. Esophageal stenting for benign and malignant disease: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy. 2016;48(10):939-48.

Ferreira F, Bastos P, Ribeiro A, Marques M, Azevedo F, Pereira P, et al. A comparative study between fluoroscopic and endoscopic guidance in palliative esophageal stent placement. Dis Esophag. 2011;25(7):608-13.

Abdelshafy M, Omar M, Abdel Bary M, Wahaman M, Bakheet R. Self-expandable metal stent for palliation of malignant dysphagia and quality of life improvement in advanced cancer esophagus: Upper Egypt experience. J Egypt Soc Cardio-Thorac Surg. 2017;25(3):262-9.

Diamantis G. Quality of life in patients with esophageal stenting for the palliation of malignant dysphagia. World J Gastroenterolo. 2011;17(2):144.

Ebigbo A, Karstensen J, Aabakken L, Dinis-Ribeiro M, Spaander M, Le Moine O, et al. Esophageal stenting for benign and malignant disease: European Society of Gastrointestinal Endoscopy (ESGE) Cascade Guideline. Endosc Int Open. 2019;07(06):E833-6.

Na H, Song H, Kim J, Park J, Kang M, Lee J, et al. How to design the optimal self-expandable oesophageal metallic stents: 22 years of experience in 645 patients with malignant strictures. Eur Radiol. 2012;23(3):786-96.

Sharma P, Kozarek R. Role of esophageal stents in benign and malignant diseases. Am J Gastroenterol. 2010;105(2):258-73.

Wang C, Wei H, Li Y. Comparison of fully-covered versus partially covered self-expanding metallic stents for palliative treatment of inoperable esophageal malignancy: a systematic review and meta-analysis. BMC Cancer. 2020;20(1).