Abstract
BackgroundPalliative treatments and stents are necessary for relieving dysphagia in patients with esophageal cancer. The aim of this study was to simultaneously compare available treatments in terms of complications.MethodsWeb of Science, Medline, Scopus, Cochrane Library and Embase were searched. Statistical heterogeneity was assessed using the Chi2 test and was quantified by I2. The results of this study were summarized in terms of Risk Ratio (RR). The random effects model was used to report the results. The rank probability for each treatment was calculated using the p-score.ResultsOut of 17855 references, 24 RCTs reported complications including treatment related death (TRD), bleeding, stent migration, aspiration, severe pain and fistula formation. In the ranking of treatments, thermal ablative therapy (p-score = 0.82), covered Evolution® stent (p-score = 0.70), brachytherapy (p-score = 0.72) and antireflux stent (p-score = 0.74) were better treatments in the network of TRD. Thermal ablative therapy (p-score = 0.86), the conventional stent (p-score = 0.62), covered Evolution® stent (p-score = 0.96) and brachytherapy (p-score = 0.82) were better treatments in the network of bleeding complications. Covered Evolution® (p-score = 0.78), uncovered (p-score = 0.88) and irradiation stents (p-score = 0.65) were better treatments in network of stent migration complications. In the network of severe pain, Conventional self-expandable nitinol alloy covered stent (p-score = 0.73), polyflex (p-score = 0.79), latex prosthesis (p-score = 0.96) and brachytherapy (p-score = 0.65) were better treatments.ConclusionAccording to our results, thermal ablative therapy, covered Evolution® stents, brachytherapy, and antireflux stents are associated with a lower risk of TRD. Moreover, thermal ablative therapy, conventional, covered Evolution® and brachytherapy had lower risks of bleeding. Overall, fewer complications were associated with covered Evolution® stent and brachytherapy.
Highlights
Esophageal cancer includes squamous cell carcinoma and adenocarcinoma
Thermal ablative therapy, covered Evolution® stents, brachytherapy, and antireflux stents are associated with a lower risk of treatment related death (TRD)
Fewer complications were associated with covered Evolution® stent and brachytherapy
Summary
Esophageal cancer includes squamous cell carcinoma and adenocarcinoma. It has an aggressive nature, a poor prognosis and a low five-year survival rate [1]. Certain treatment options have been developed to relieve the pain and dysphagia, including the stent, brachytherapy, and external radiotherapy [3]. Many RCTs have been conducted to assess the effectiveness of stents and palliative treatments among patients with advanced esophageal cancer [5,6,7,8,9,10]. These RCTs have reported adverse events for stent placement and other palliative treatments such as brachytherapy and thermal ablative treatment in patients, including TRD, bleeding, stent migration, fistula formation, and aspiration. Palliative treatments and stents are necessary for relieving dysphagia in patients with esophageal cancer. The aim of this study was to simultaneously compare available treatments in terms of complications
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