Preliminary Results of Temporary Placement of Retrievable Expandable Metallic Stents during Preoperative Neoadjuvant Chemoradiotherapy in Patients with Resectable Esophageal Cancer

Abstract

PurposeTo evaluate the clinical efficacy of temporary placement of a retrievable expandable metallic stent (REMS) during preoperative neoadjuvant chemoradiotherapy (CRT) in patients with resectable esophageal cancer. Materials and MethodsREMSs were placed in 25 patients who underwent preoperative neoadjuvant CRT for resectable esophageal cancer. Stent removal was scheduled between 4 and 6 weeks after starting neoadjuvant CRT. Clinical effectiveness was assessed using the following variables: technical and clinical success, dysphagia score before and after stent placement and removal, and complications and their management. ResultsREMS placement was technically successful in all patients, with 24 of 25 patients (96%) showing symptomatic improvement. Stents were removed electively 32 days (range, 27–42 d) after starting neoadjuvant CRT (n = 20; 80%) or after stent migration and exit through the anus with no evidence of symptom recurrence (n = 5; 20%). The dysphagia score (before stent, 3.1 ± 0.5) improved by 3 days after stent placement (1.3 ± 0.4; P < .001) and was maintained up to 1 month after stent removal (1.2 ± 0.7; P < .001). The median survival was 18.6 months. ConclusionsIn patients with resectable esophageal cancer, temporary placement of a REMS during preoperative neoadjuvant CRT showed clinical efficacy in the bridge to surgery. Stent removal between 4 and 6 weeks after starting neoadjuvant CRT seems to be a feasible time frame with symptom improvement.