Introduction Oesophageal cancer is the seventh leading cause of cancer death worldwide. Unfortunately the majority of patients with oesophageal carcinoma are incurable at diagnosis. Self-expanding metal stents (SEMs) are effective palliation for relieving dysphagia. The aim of this study was to determine survival duration following oesophageal stenting for malignant strictures and to identify potential factors that predict a poor outcome.
Methods We undertook a retrospective analysis to evaluate the outcome of patients following SEMs for malignant oesophageal strictures and possible prognostic factors over 6-year period (2004–2010). We analysed the Salisbury oesophageal stent database, reporting system and patient clinical management database to obtain data. We recorded age, sex, date of diagnosis stent and death, type of cancer, haemoglobin, creatinine, CRP and albumin, and whether chemotherapy or radiotherapy had been given. The results were statistically analysed using the unpaired t-Test and Pearson's correlation coefficient.
Results Between June 2004 and December 2010 we identified 128 patients who had one or more SEM inserted. One patient was excluded from the analysis. 46 (36%) patients were female and 81 (64%) male with a mean age of 76.7 (range 35–98). Adenocarcinoma accounted for 87 (69%) patients, 38 (30%) squamous cell carcinoma, and two others. The mean life expectancy was 147 days (range 8–1028 days) following the first stent deployment and 273 days (range 1–928 days) from diagnostic endoscopy. The 30-day mortality was 10%. There was no difference in mortality when age (p=0.19), sex (p=0.35), haemoglobin (p=0.23), CRP (p=0.34), albumin (p=0.36) or creatinine (p=0.28) were compared. Patients with adenocarcinoma had a mean survival 163 days from initial stent which was statistically better than 108 days in the squamous cell carcinoma group (p=0.09). Patients receiving chemotherapy or chemoradiotherapy survived on average 18 days longer than those who had SEMs alone, regardless of histology (p<0.0001).
Conclusion Incurable oesophageal cancer has a bleak prognosis, but survival after SEMs is significant. In our study age, sex, and simple laboratory investigations were not predictive of mortality following SEMs. This suggests that it is not possible to estimate survival using any of these factors, and palliative SEMs should be considered in all patients. Squamous cell carcinoma has a significantly shorter life expectancy than adenocarcinoma following palliative SEMs. Those patients who had adjuvant chemotherapy or chemoradiotherapy had significantly improved survival, either due to the direct effect of the treatment or because of selection of fitter patients. Our data offers useful survival and 30-day mortality figures to help inform patients and make clinical management decisions.
Competing interests None declared.
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