Self-expandable metal stents in esophageal cancer before preoperative neoadjuvant therapy: efficacy, safety, and long-te
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and Other Interventional Techniques
Self‑expandable metal stents in esophageal cancer before preoperative neoadjuvant therapy: efficacy, safety, and long‑term outcomes Eduardo Rodrigues‑Pinto1,2 · Joel Ferreira‑Silva1,2 · Bernardo Sousa‑Pinto3,4 · Renato Medas1 · Isabel Garrido1 · Peter D. Siersema5 · Pedro Pereira1,2 · Guilherme Macedo1,2 Received: 7 July 2020 / Accepted: 16 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background Self-expandable metal stent (SEMS) placement for malignant dysphagia before preoperative neoadjuvant therapy (NT) is controversial. Aim Evaluate SEMS placement impact on clinical and oncologic outcomes in patients with esophageal cancer who underwent surgery after NT. Methods Retrospective study of esophageal cancer patients referred for esophagectomy after NT. A propensity score was built consisting of the conditional probability of having had a SEMS given a set of baseline variables. In the SEMS group, patients underwent SEMS placement followed by NT and esophagectomy, whereas in the non-SEMS group, patients underwent only NT and esophagectomy. Results One hundred patients were included, 29 in the SEMS group and 71 in the non-SEMS group. Median follow-up was 18 months. SEMS-related adverse events occurred in 20.7% of the patients. After propensity score analysis, SEMS use decreased delta dysphagia score (regression coefficient [RC]: − 2.69, 95% CI − 3.18 to − 2.21), dysphagia grade before surgery (RC: − 0.74, 95% CI − 1.22 to − 0.27), hospital readmissions at 1 month (OR 0.18; p = 0.019), but increased overall morbidity after surgery (OR 3.02; p = 0.045). No significant differences were found regarding delta albumin levels and albumin levels before surgery, delta weight and weight before surgery, death related to surgery, number of lymph nodes harvested, R0 resection rate, tumor recurrence, recurrence-free survival, overall survival, and 30-day, 6-month, and 3-year mortality. Conclusion SEMS placement improved dysphagia and allowed patients to maintain an equal nutritional status compared to patients without dysphagia during NT. Although postsurgical morbidity was higher in patients with SEMS placement, postsurgical mortality and oncological outcome were not different. Keywords Esophageal cancer · Esophagectomy · Neoadjuvant therapy · Self-expandable metal stents
Eduardo Rodrigues-Pinto and Joel Ferreira-Silva have contributed equally in the design, conception, analysis, and paper writing. * Eduardo Rodrigues‑Pinto [email protected] 1
Gastroenterology Department, Centro Hospitalar São João, Porto. Al. Prof. Hernâni Monteiro, 4200–319 Porto, Portugal
2
Faculty of Medicine of the University of Porto, Porto, Portugal
3
MEDCIDS – Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Porto, Portugal
Esophageal cancer patients commonly present with dysphagia due to an advanced tumor at the time of diagnosis [1]. Dysphagia contributes to weight loss and
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