Palliative esophageal stent or surgery in advanced esophageal malignancy

Abstract

Esophageal malignancy is one of the most aggressive malignancies. Unfortunately, the majority of patients present with incurable disease. Then palliative treatment to relieve dysphagia is the mainstay of treatment. We compared the mortality, procedure-related complications, hospital stay, intervention time, improvement of dysphagia and survival time between esophageal stent and surgery. There were twenty patients who underwent esophageal stent and twenty-three patients underwent surgical treatment. Pretreatment characteristics were similar between the two groups. The mortality between the surgical group and the esophageal stent group was 30.43 per cent (7/23) and 5 per cent (1/20) (p<0.05). The complications in the surgical group included anastomotic leakage 39.13 per cent (9/23), wound dehiscence 4.35 per cent (1/23), small bowel obstruction 4.35 per cent (1/23) and late anastomotic stricture 37.5 per cent (6/16). In the esophageal stent group, the complications were severe chest pain 10 per cent (2/20), stent displacement 10.52 per cent (2/19), stent obstruction from food impaction 15.78 per cent (3/19) and tumor overgrowth leading to stent obstruction 5.26 per cent (1/19). More intervention time and hospital stay (post intervention period and ICU period) was spent in the surgical group (320.43+/-133.84 mins vs 57.5+/-23.98 mins p<0.001, 30.39+/-20.69 days vs 4.9+/-2.61 days p<0.001, 9.79+/-16.64 days vs 0 days p<0.05). The improvement of dysphagia was 1.00+/-1.03 vs 1.75+/-0.72 (p<0.05). Survival between the two groups was not statistically different (p>0.05).