Stents for proximal esophageal cancer: a case-control study

BackgroundSelf-expandable metal stents (SEMSs) are an established palliative therapy for esophageal cancer. SEMS placement for cancers near the upper esophageal sphincter (UES) is controversial because of a perceived increased risk of complications.ObjectiveTo compare outcomes after patients stented for proximal esophageal cancer (PC) and distal esophageal cancer (DC).DesignMatched case-control study from a prospective database.SettingTertiary referral center, Tenwek Hospital, Bomet, Kenya.PatientsAll patients with PC located within 6 cm of the UES were matched with randomly selected controls with DC.InterventionsOutcomes of PC cases were compared with those of DC controls.Main Outcome MeasurementsDysphagia score, complications, median survival.ResultsA total of 151 patients with PC were identified and were randomly matched with DC controls. Ninety-three case-control pairs had adequate follow-up information available. Mean dysphagia scores (scale 0-4) improved from 3.4 and 3.3 before stenting for PC and DC, respectively, to 1.5 after stenting for both groups (P = .93). Early complications occurred in 6.5% of PC cases and 9.7% of DC controls (P = .44). Late complications occurred in 20.4% of PC cases and 15.1% of DC controls (P = .25). Median survival was 210 days for PC cases and 272 days for DC controls (P = .25). Outcomes were similar for the subgroup of PC cases whose cancer extended to within 2 cm of the UES.LimitationAn important limitation is the absence of adequate follow-up data for 58 of the 151 case-control pairs.ConclusionsSEMSs effectively palliate dysphagia in PC cases, whereas complication and survival rates are not statistically different from those of DC controls.