Outcomes of esophageal bypass surgery and self-expanding metallic stent insertion in esophageal cancer: reevaluation of
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ORIGINAL ARTICLE
Outcomes of esophageal bypass surgery and self-expanding metallic stent insertion in esophageal cancer: reevaluation of bypass surgery as an alternative treatment Daichi Nomoto 1 & Yoshifumi Baba 1,2 & Takahiko Akiyama 1 & Kazuo Okadome 1 & Tomoyuki Uchihara 1 & Kazuto Harada 1 & Kojiro Eto 1 & Yukiharu Hiyoshi 1 & Yohei Nagai 1 & Takatsugu Ishimoto 1 & Masaaki Iwatsuki 1 & Shiro Iwagami 1 & Yuji Miyamoto 1 & Naoya Yoshida 1 & Masayuki Watanabe 3 & Hideo Baba 1,4 Received: 6 April 2020 / Accepted: 16 August 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Advanced esophageal cancer often results in esophageal stenosis or tracheoesophageal fistula. Esophageal bypass surgery and esophageal stent insertion are palliative treatments for esophageal cancer. With improvements in metallic stents and the stent insertion technique, esophageal stent insertion appears to be performed more frequently than bypass surgery, worldwide. The aim of this study was to evaluate the outcomes of bypass surgery and stent insertion in our hospital and reevaluate which patients would benefit from bypass surgery. Methods A total of 70 esophageal cancer patients who could not tolerate oral feeding due to esophageal stenosis or tracheoesophageal fistula underwent palliative treatment [esophageal bypass surgery (N = 34) and esophageal stent insertion (N = 36)] at Kumamoto University. We retrospectively investigated the clinicopathological factors, postoperative outcomes, and complications. Results Both treatments could significantly improve the amount of food intake and the dietary form (P < 0.01). The length of hospital stay was shorter (P < 0.01) and complications associated with treatment were reduced in the stent group (P = 0.03). The overall survival did not differ significantly between the groups (log rank P = 0.22). Importantly, in the bypass surgery group, the patients who received postoperative treatment had a better prognosis than those who did not receive postoperative treatment (log rank P < 0.01). Conclusion Both bypass surgery and stent insertion allowed oral intake in patients who could not tolerate oral feeding because of esophageal stenosis or tracheoesophageal fistula. Considering that patients who undergo stent insertion have a shorter hospital stay and fewer complications, stent insertion may be a better first choice for treatment than bypass surgery. However, bypass surgery may be an option for patients who can tolerate postoperative treatment. Keywords Esophageal cancer . Bypass surgery . Stenosis . Fistula
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00423-020-01969-x) contains supplementary material, which is available to authorized users. * Hideo Baba [email protected]
3
Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo 135-8550, Japan
1
Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Ku
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