Esophageal metal stent for malignant obstruction after prior radiotherapy

Hiroyoshi Iwagami,Noriko Matsuura,Noriya Uedo Noriya Uedo,Sachiko Yamamoto,Mitsuhiro Kono,Katsunori Matsueda,Muneaki Miyake,Hiromu Fukuda,Kotaro Waki,Hiroko Nakahira,Koji Higashino,Takahiro Inoue,Satoki Shichijo,Yoji Takeuchi,Ryu Ishihara,Takashi Kanesaka,Akira Maekawa,Yusaku Shimamoto,Ayaka Shoji

doi:10.1038/s41598-021-81763-x

Hiroyoshi Iwagami, Noriko Matsuura + Show 17 more

Open Access

https://doi.org/10.1038/s41598-021-81763-x

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Journal: Scientific Reports	Publication Date: Jan 22, 2021
Citations: 8	License type: open-access

Affiliation: Osaka International Cancer Institute

Abstract

The association between severe adverse events (SAEs) and prior radiotherapy or stent type remains controversial. Patients with esophageal or esophagogastric junctional cancer who underwent stent placement (2005–2019) were enrolled in this retrospective study conducted at a tertiary cancer institute in Japan. The exclusion criteria were follow-up period of < 1 month and insufficient data on stent type or cancer characteristics. We used Mann–Whitney’s U test for quantitative data and Fisher’s exact test for categorical data. Multivariate analysis was performed using a logistic regression model. 107 stents were placed. Low radial-force stents (L group) were used in 51 procedures and high radial-force stents (H group) in 56 procedures. SAEs developed after nine procedures, the median interval from stent placement being 6 days (range, 1–141 days). SAEs occurred more frequently in the H (14%: 8/56) than in the L group (2%: 1/51) (P = 0.03). In patients who had undergone prior radiotherapy, SAEs were more frequent in the H (36%: 4/11) than in the L group (0%: 0/13) (P = 0.03). Re-obstruction and migration occurred after 16 and three procedures, respectively; these rates did not differ significantly between groups (P = 0.59, P = 1, respectively). Low radial-force stents may reduce the risk of SAEs after esophageal stenting.

Highlights

The association between severe adverse events (SAEs) and prior radiotherapy or stent type remains controversial
When we compared the incidence of SAEs by stent type (Table 2), we found that SAEs developed more frequently in the high radial force (14%, 8/56 procedures) than in the low radial force stent group (2%, 1/51 procedures) (P = 0.03)
The results of these studies12,22 regarding the relationship between the risk of SAEs and radial force are in agreement with the present findings

Summary

Introduction

The association between severe adverse events (SAEs) and prior radiotherapy or stent type remains controversial. In patients who had undergone prior radiotherapy, SAEs were more frequent in the H (36%: 4/11) than in the L group (0%: 0/13) (P = 0.03). Adverse events associated with stent placement occur at a frequency of 5–65%8–11. Prior RT has been reported as a factor associated with adverse events in many studies. Adverse events associated with stents, such as esophagitis, dehydration, anorexia, migration and fistula formation, occur more frequently in patients who have undergone previous CRT than in those who have undergone stent placement a lone. A meta-analysis found no relationship between adverse events after stent placement and prior RT or CRT. Some studies failed to identify a significant association between stent type and adverse events whereas in other studies Gianturco-Z stents as compared with Ultraflex stents and Flamingo W allstents; Ultraflex stents as compared with Covered Evolution

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