P-0008 Follow-up Results of Expendable Metal Stents for Malignant Esophageal Obstruction and Fistulae in 177 Patients

Abstract

ABSTRACT Introduction Expendable metal stents palliate malignant esophageal obstruction and fistulae in most cases, but complications and failures have not been well described in cardiac cancer with esophageal invasion as well as esophageal and lung cancer. Methods Over a ten-year period, 202 stents were placed in 177 patients with malignant esophageal obstruction and fistulae from esophageal cancer, lung cancer or Cardiac cancer with esophageal invasion. Early and late complications, duration of palliation, and reintervention were evaluated. Results A total of 202 expandable metal stents were placed in 177 patients for malignant dysphagia caused by esophageal cancer (52.5%), lung cancer (35.6%), or cardiac cancer (11.9%). The tumor locations were proximal in 5, mid in 85, and distal in 88. The mean age of patients was 66.75 years (range, 37 to 89 years); 154 were men, and 70 patients had stage IV disease. In most patients need an admission (162 to 177, 91.5%), and average length of admission was 19.7 days. 29 of the 202 cases (14.4%) who achieved early clinical success with stent insertion had long-term clinical failure. The most common causes of late clinical failure were tumor ingrowth and overgrowth (15 patients, 7.4%), followed by stent migration (14 patients, 6.9%). Major complications occurred in 1 patient diagnosed esophageal cancer stage IV. After palliative esophageal stent insertion, he expired of aspiration pneumonia was caused by septic shock. When comparing the esophageal, lung, and cardiac caner groups, age, gender, fistula status, and location were significantly different from each other. And complications were correlated to failure and type of reintervention. Conclusion Expandable metal stents offer excellent palliation of malignant obstruction, but recurrent obstruction requiring reintervention is common. And in radiation induced esophageal stricture group, major complications were not observed, but in broncho-esophageal fistula subgroup, major complications were observed.