Introduction

Oesophageal self-expandable metallic stent (SEMS) placement is useful in malignant dysphagia palliation. However, its safety in patients undergoing chemoradiotherapy (CRT) remains unclear.

Aims & Methods

Our aim was to evaluate the safety of SEMS placement in these patients.
Retrospective study of consecutive patients between July 2012 and August 2023, with malignant dysphagia and inoperable tumors, who underwent SEMS placement alone or with oncologic treatment (CRT or chemotherapy (CT)) in a tertiary center. Demographic, tumor and stent characteristics, complications and follow-up data were collected.

Results

44 patients were included; 86.4% male; median age 68.3 IQR 39-97 years; 70.5% (n=31) with esophageal squamous cell carcinoma and 29.5% (n=13) with esophagogastric junction adenocarcinoma. Patients were in stage IV (72.7%, n=32) and stage III (27.3%, n=12). A partially covered SEMS was placed in most cases (90.9%, n= 40), and a fully covered SEMS in the remainder 4 patients. Median follow-up was 76 days (IQR 2-417 days). One third of patients (n=15) underwent CRT: nine priors, four after and two before and after SEMS placement. Seven patients only had CT: five after and two before and after stent placement. The remaining 50% did not undergo CRT nor CT. The overall median survival was 81.5 days (IQR 42.8-115). Survival was similar between patients with and without oncologic treatment 81.5 versus 77.5 days. Major complications occurred in 15.9%: six perforations and one hemorrhage. Severe complications were similar between patients with or without oncologic treatment peri stent placement. Similarly, there was no difference in complications between partially and fully covered SEMS (15% vs 25%, p=0.602).

Conclusion

In our cohort, CRT or CT did not increase the rate of major complications of SEMS placement for malignant dysphagia palliation.

References

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Kinsman KJ, et al. Prior radiation and chemotherapy increase the risk of life-threatening complications after insertion of metallic stents for esophagogastric malignancy. Gastrointest Endosc. 1996 Mar; 43(3):196-203.

Machado AA, et al. Impact of radiotherapy on adverse events of self-expanding metallic stents in patients with esophageal cancer. Dis Esophagus. 2023 Sep 30; 36(10): doad019.