A Nationwide Study of the Use of Self-Expanding Stents in Patients with Esophageal Cancer in Sweden

Background and Study Aims: Endoscopic insertion of self-expanding metal stents is used for palliative treatment of esophageal and cardia cancer, but the safety profiles, and the influence of age, sex, and hospital volume have not previously been evaluated in a population-based setting.
Patients and Methods: A retrospective population-based study was conducted, including all patients treated with esophageal stenting for malignant disease recorded in Swedish national registries in the period 1997 - 2000. Patients with esophageal or cardia cancer were identified in the cancer registry, and those treated with esophageal stenting were selected from the in-patient registry. Survival and emigration were assessed using the registries for causes of death and emigration, respectively. Procedure-related complications were assessed by reviewing medical records.
Results: Among 1052 registered patients with esophageal or cardia cancer, 402 patients (38 %), with a median age of 74 years, were treated with esophageal stenting. After treatment, the median in-hospital stay was 7 days, and the median survival was 100 days. Survival times were similar between age groups and sexes. Stenting was conducted at 38 Swedish hospitals, with a range of 1-59 procedures at each hospital. Among 152 (38 %) patients who were evaluated for complications, 41 (27 %) had complications of some type, while 20 (13 %) experienced direct procedure-related complications. No differences in complication frequencies were found between high-volume and low-volume centers. There were only two procedure-related deaths (1 %), both due to esophageal perforation. No reduction in the median survival time was found in patients with complications.
Conclusions: Treatment with self-expanding metal stents is a widely used and reasonably safe procedure among patients with malignant dysphagia, independent of sex, age, or hospital volume in Sweden.

References

• 1 Berrino F, Gatta G, Chessa E. et al . Introduction: the EUROCARE II Study.  Eur J Cancer. 1998;  34 (14 Spec No) 2139-2153
• 2 Sundelof M, Ye W, Dickman P W, Lagergren J. Improved survival in both histologic types of oesophageal cancer in Sweden.  Int J Cancer. 2002;  99 751-754
• 3 Wong R, Malthaner R. Esophageal cancer: a systematic review.  Curr Probl Cancer. 2000;  24 297-373
• 4 Allum W H, Griffin S M, Watson A, Colin-Jones D. Guidelines for the management of oesophageal and gastric cancer. Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland; British Society of Gastroenterology; British Association of Surgical Oncology.  Gut. 2002;  50 (Suppl 5) v1-v23
• 5 Reed C E, Marsh W H, Carlson L S. et al . Prospective, randomized trial of palliative treatment for unresectable cancer of the esophagus.  Ann Thorac Surg. 1991;  51 552-555; discussion 556
• 6 Wu W C, Katon R M, Saxon R R. et al . Silicone-covered self-expanding metallic stents for the palliation of malignant esophageal obstruction and esophagorespiratory fistulas: experience in 32 patients and a review of the literature.  Gastrointest Endosc. 1994;  40 22-33
• 7 Blot W J. Esophageal cancer trends and risk factors.  Semin Oncol. 1994;  21 403-410
• 8 Lambert R. Palliation of carcinoma of the esophagus: is there a hope for cure?.  Am J Gastroenterol. 1994;  89 (8 Suppl) S27-S40
• 9 Grund K E, Noetzel J, Zindel C. [Esophageal carcinoma: downstaging or stent? In German.]  Langenbecks Arch Chir Suppl Kongressbd. 1996;  113 755-758
• 10 Cowling M G. Stenting in the oesophagus.  Hosp Med. 2000;  61 33-36
• 11 Tytgat G N, den H artog, Bartelsman J F. Endoscopic prosthesis for advanced esophageal cancer.  Endoscopy. 1986;  18 (Suppl 3) 32-39
• 12 Dormann A J, Eisendrath P, Wigginghaus B. et al . Palliation of esophageal carcinoma with a new self-expanding plastic stent.  Endoscopy. 2003;  35 207-211
• 13 Frimberger E. Expanding spiral: a new type of prosthesis for the palliative treatment of malignant esophageal stenoses.  Endoscopy. 1983;  15 (Suppl 1) 213-214
• 14 Lambert R. Treatment of esophagogastric tumors.  Endoscopy. 2003;  35 118-126
• 15 Petruzziello L, Costamagna G. Stenting in esophageal strictures.  Dig Dis. 2002;  20 154-166
• 16 Osugi H, Lee S, Takemura M, Higashino M. [Self-expandable metallic stent for unresectable malignant esophageal stricture; in Japanese.]  Nippon Geka Gakkai Zasshi. 2003;  104 544-548
• 17 Lee S H. The role of oesophageal stenting in the non-surgical management of oesophageal strictures.  Br J Radiol. 2001;  74 891-900
• 18 Siersema P D, Schrauwen S L, van Blankenstein M. et al . Self-expanding metal stents for complicated and recurrent esophagogastric cancer. Rotterdam Esophageal Tumor Study Group.  Gastrointest Endosc. 2001;  54 579-586
• 19 Schaffer S B, Hebert A F. Caustic ingestion.  J La State Med Soc. 2000;  152 590-596
• 20 Konigsrainer A, Riedmann B, De Vries A. et al . Expandable metal stents versus laser combined with radiotherapy for palliation of unresectable esophageal cancer: a prospective randomized trial.  Hepatogastroenterology. 2000;  47 724-727
• 21 Mattsson B, Wallgren A. Completeness of the Swedish Cancer Register. Non-notified cancer cases recorded on death certificates in 1978.  Acta Radiol Oncol. 1984;  23 305-313
• 22 Siersema P D, Hop W C, van Blankenstein M. et al . A comparison of 3 types of covered metal stents for the palliation of patients with dysphagia caused by esophagogastric carcinoma: a prospective, randomized study.  Gastrointest Endosc. 2001;  54 145-153
• 23 Enzinger P C, Mayer R J. Esophageal cancer.  N Engl J Med. 2003;  349 2241-2252
• 24 May A, Hahn E G, Ell C. Self-expanding metal stents for palliation of malignant obstruction in the upper gastrointestinal tract: comparative assessment of three stent types implemented in 96 implantations.  J Clin Gastroenterol. 1996;  22 261-266
• 25 De Palma G D, Galloro G, Sivero L. et al . Self-expanding metal stents for palliation of inoperable carcinoma of the esophagus and gastroesophageal junction.  Am J Gastroenterol. 1995;  90 2140-2142
• 26 Lapenta R, Assisi D, Grassi A. et al . Palliative treatment of esophageal tumors.  J Exp Clin Cancer Res. 2002;  21 503-507
• 27 Siersema P D, Marcon N, Vakil N. Metal stents for tumors of the distal esophagus and gastric cardia.  Endoscopy. 2003;  35 79-85
• 28 Kocher M, Dlouhy M, Neoral C. et al . [Palliative treatment of inoperable esophageal stenoses using stents: long-term results, complications; in Czech.]  Rozhl Chir. 1998;  77 51-55
• 29 Cwikiel W, Tranberg K G, Cwikiel M, Lillo-Gil R. Malignant dysphagia: palliation with esophageal stents - long-term results in 100 patients.  Radiology. 1998;  207 513-518
• 30 Song H Y, Do Y S, Han Y M. et al . Covered, expandable esophageal metallic stent tubes: experiences in 119 patients.  Radiology. 1994;  193 689-695
• 31 Kozarek R A. Esophageal stenting: when should metal replace plastic?.  Endoscopy. 1998;  30 575-577
• 32 Siersema P D, Dees J, van Blankenstein M. Palliation of malignant dysphagia from oesophageal cancer. Rotterdam Oesophageal Tumor Study Group.  Scand J Gastroenterol Suppl. 1998;  225 75-84